they should be able to adjudicate at the border of whether they are seeking asylum. i've heard a month. it can be longer because they are being prosecuted and detaine d, that is being dealt with first and then the immigration component. in may even be longer which is why we need to look at the system to make it as just but as quick as possible for everyone. host: democrat line from indianapolis, ishmael. caller: good morning, gentlemen. pursuant to clause 8 of rule 20, the chair will postpone further proceedings today on motions to suspend the rules on which a recorded vote or the yeas and nays are ordered. or votes objected to under clause 66 rule 20. the house will resume proceedings on postponed questions at a later time. for what purpose does the gentleman from oregon seek recognition. mr. walden: thank you, mr. speaker. i move the house suspend the rules and pass the bill h.r. 3192, as amended. the speaker pro tempore: the

clerk will report the title of the bill. the clerk: h.r. 3192, a bill to amend title 21 of the social security act to ensure access to mental health services for children under the children's health insurance program, and for other purposes. the speaker pro tempore: pursuant to the rule, the gentleman from oregon, mr. walden, and the gentleman from maachusetts, mr. kennedy, will each control 20 minutes. the chair recognizes gentleman from oregon. mr. walden: thank you, mr. speaker. i ask unanimous consent that all members may have five legislative days to revise and xtend their remarks and insert extraneous materials on the bill. mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. walden: thank you, mr. speaker. mr. speaker, last week the house advanced tozzes of bills to help save the lives and stem the tide of the opioid crisis that has struck at the health of our people. wherever they live. we're back here again this week to consider additional legislation that can help our communities fight back against this epidemic. we have allred the headlines about this tragedy. we have heard the stories first hand across our respective

districts. addiction nting an that mercilessly seizes control and then destroys. this killer does not discriminate, not by age, not by race, not by where you live, or by what you believe. opioid addiction continues to take the lives of more than 100 americans every single day. add but it's what's behind the numbers that really matters. these are real people. their stories are real. they tragically have lost their bright futures and left loved ones sadly behind. so we have come together to advance legislation that will help put a stop to this unprecedented crisis that has left a mark on just about every family across america. i urge my colleagues to support the legislation before the house today. we have various bills and throughout the course of this week. we have an opportunity to save lives and we have a responsibility to our families,

our friends, our communities, and our nation to lift people out of addiction and get america on a better path. the first bill up this afternoon, mr. speaker, is sponsored by our colleague from massachusetts, representative kennedy. it requires the children's health insurance programs to cover comprehensive mental health and substance use disorder services for pregnant women and children. the state chip programs may be offered by expanding medicaid, separate programs that stand alone from medicaid, or chip may be offered through a combination of both approaches. each of these types of children's health insurance programs covers some mental health services but not all covers substance use disorder services. so there is a gap. this bill requires the children's health insurance programs, regardless of type, to cover mental health services, including substance use disorder services. the bill requires states with separate chip programs to mental health to

and substance use disorder services. finally, the bill requires states with separate chip programs to ensure the mental health parity with group health plans is met. most chip programs already meet the standards in this bill. this is simply a codification, current practices and does so without additional costs. so it's important. mr. speaker, i thank you for bringing this bill to the floor. i congratulate my colleague from massachusetts had brought this mental health issue to our. i reserve the balance my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from massachusetts is recognized. mr. kennedy: thank you, mr. speaker. mr. speaker, i rise in support of 3192. i want to begin by thanking the chairman of our committee, mr. us a hearing ving on this bill and for moving the process forward. us a hearing on this bill and for moving the process forward. thank you, sir. along with dr. burgess, ranking member pallone, ranking member o co-sponsor,

democratic co-lead, mrs. napolitano, as well. a couple decades ago my uncle, senator edward kennedy, and senator orrin hatch, created he chip program because of a consensus that children consensus that children should never be caught in the midst of our debates over health care. it has been a successful, o co- democratic co-lead, bipartisan program that has saved lives and helped families facing their deepest despair. but just like any program, mr. speaker, it has been a work in progress. this bill offers a simple fix to a troubling problem. according to some estimates, nearly 500,000 children and pregnant mothers covered by chip are not guaranteed mental health care or substance use disorder treatment. we have guaranteed that treatment for americans covered by medicaid, private insurance, and employer-sponsored insurance. it's time we do so for low-income families and babies as well. in our efforts to confront an opioid epidemic that cares for no age, no income, no race,

nothing at all, this bill is a crucial piece of our response. with that, mr. speaker, i'd like it thank everyone at the legislative council's office, c.m.s., staff on both sides of the aisle for the energy and commerce committee, and particular rachel pryor for putting up with my relentless and sometimes misguided questions. that that i yield back. the speaker pro tempore: the gentleman from massachusetts yields back. the gentleman from oregon is recognized. mr. walden: mr. speaker, i have no other speakers on this matter. i know the gentleman's yielded back. i'll to the same after calling on our colleagues to support this important and meaningful legislation. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the question is, will the house suspend the rules and pass the bill h.r. 3192, as amended. so many as are in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed, and without objection the motion to reconsider is laid upon the table. for what purpose does the

gentleman from oregon seek recognition. mr. walden: i move the house suspend the rules and pass the bill h.r. 4005 as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: union calendar number 564, h.r. 4005. a bill-to-amend title 19 of the social security act to allow for medical assistance under medicaid for inmates during the 30-day period preceding release from a public institution. the speaker pro tempore: pursuant to the rule, the gentleman from oregon, mr. walden, and the gentleman from massachusetts, mr. kennedy, each will control 20 minutes. the chair recognizes the gentleman from oregon. mr. walden: thank you, mr. speaker. i ask unanimous consent that all members may have five legislative days to revise and and insert remarks extraneous materials in the record on the bill. the speaker pro tempore: without objection. mr. walden: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. walden: thank you, mr. speaker. this bill responsible youred by representative tonko of -- sponsored by representative tonko of nork, and representative turner of ohio and myself requires the secretary of health and human services to convene a stakeholder group that will publish a report on best

practices for how states can address the health considerations of incarcerated individuals as they transition back into our communities. mr. speaker, the kaiser family foundation reports that in states such as connecticut and massachusetts, 60% to 70% of inmates are eligible for enroll n-medicaid upon release. according to 2002 data from the department of justice, about 68% of incarcerated individuals met the criteria for substance dependence or abuse. this bill requires c.m.s. to issue best practices for improving transitions back to the community, including systems for enrollment support, substance use treatment, and related services for individuals who are inmates of a public institution and who are eligible for medicaid. c.m.s. has to do that within a year after this bill is enacted. these best practices should help both the congress and states get a handle on how to help these incarcerated individuals get back on their feet. that's our goal. my thanks to mr. tonko for his

leadership on this issue. i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from massachusetts is recognized. mr. kennedy: thank you, mr. speaker. i would like to yield to my colleague, mr. tonko, from new york, such time he may consume. the speaker pro tempore: the gentleman from new york is recognized. mr. tonko: thank you, mr. speaker. i thank the gentleman from massachusetts for yielding. i rise in strong support of the medicaid re-entry act. i urge all members to support its swift passage in the house. bill is about saving lives. pure and simple. 64,000 americans die of a drug overdose in drug 2016. more than lost at the peek of the h.i.v. aides crisis. we can estimate that as many as 10,000 of those deaths annually are individuals who have had some interaction with the criminal justice system in the previous year. this is a national emergency that demands immediate action.

individuals who are returning to society after a stay in a corrections facility are particularly vulnerable to overdose deaths. research has found that formerly incarcerated individuals re-entering society are 129 times more likely to die of an overdose during their first two weeks back into the community than the general population. the risk of overdose is elevated during this period due to reduced physicalological tolerance for opioids among the incarcerated population. a lack of effective addiction treatment options while incarcerated, and perhaps more care transitions back into their given community. according to the bureau of justice statistics, roughly 60% of our incarcerated population has a substance use disorder. yet only around one quarter of those are receiving any type of treatment. even for those receiving treatment, out of the roughly 5,000 jails and prisons in our

country, fewer than 40 provide medication assisted addiction treatment using methadone or others which along with another drug is considered the gold stabbed in treeding opioid use disorder. those that do offer full-scale m.a.t. services are seeing results. . individuals shared anecdotes with me about how access to treatment has transformed their lives for the better. we've seen even more compelling data from the state of rhode island, where a comprehensive addiction treatment program offering access to all f.d.a.-approved forms of medication-assisted treatment in state corrections facilities, was able to lower deaths in the first year, postrelease, by a staggering 61%. my legislation would open the door to more of these success stories and is designed to increase state flexibility in the medicaid program to address

this vulnerable population during the 30 days prior to an individual's release. as amended, the medicaid re-entry act would require the secretary of health and human services to release guidance to state medicaid directors on demonstration opportunities that would allow states to waive the current medicaid inmate payment restriction during this pre-release period so, that individuals could better access mental health and addiction care, and have an improved care transition back into the community. by passing this bill, we can allow states to expand innovative approaches to re-entry that are already under way in places such as new york, ohio, new mexico and rhode island. i thank our energy and commerce chair, greg walden, and ranking member pallone, and their staffs for the constructive collaboration on this bill. and i also would like to thank my republican co-lead, representative mike turner, for his efforts to help shine a light on this vulnerable

population. in closing, mr. speaker, while i would have liked to have gone even further with this effort, i believe that this smart-on-crime legislation will plant the seeds for meaningful change and will help to give individuals re-entering society a fighting chance to live a healthier, drug-free life. with that, i urge my colleagues to support this legislation and i yield back, mr. speaker. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: i'll continue to reserve. i have no other speakers on this matter. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from massachusetts is recognized. mr. kennedy: thank you, mr. speaker. just to speak briefly. i wanted to also endorse h.r. 4005 the medicaid re-entry act. one particular vulnerable population for overdose are individuals that are re-entering society postincarceration. incarcerated individuals, as my colleague, mr. tonko, indicated are far more likely to suffer from substance use disorder. without tro proper transition planning and treatment -- without proper transition planning and treatment, they're at risk of dying from overdose

after release. this legislation seeks to get at that problem. mr. speaker, over the course of the hearings that we've had on all of these bills, there's not been a more dedicated, poignant or powerful speaker in those hearings than mr. tonko. is is an issue that he cares passionately about. eyes put that neefert text in -- he's put that effort into text in this bill and i urge the thousand adopt it. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: mr. speaker, i have no further speakers on this bill. i support it, would encourage our colleagues to do the same. and i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the question is, will the house suspend the rules and pass the bill, h.r. 4005, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and, without objection, the motion to reconsider is laid on the table. without objection, the title is

amended. for what purpose does the gentleman from oregon seek recognition? mr. walden: mr. speaker, i move the house suspend the rules and pass the bill, h.r. 5687, as amended. the speaker pro tempore: the clerk will report the title of the bill. 5687, a bill to require improved packaging and disposal methods for the -- with respect to certain drugs and for other purposes. the speaker pro tempore: pursuant to the rule, the gentleman from oregon, mr. walden, and the gentleman from massachusetts, mr. kennedy, each will control 20 minutes. the chair recognizes the gentleman from oregon. mr. walden: thank you, mr. speaker. i ask unanimous consent that all members may have five legislative days to revise and extend their remarks and insert extraneous materials in the record on the bill. mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. walden: thank you, mr. speaker. i rise in strong support of this bipartisan legislation. i want to thank representatives hudson and butterfield, both of north carolina, for their hard

work on it. opioids are often prescribed in higher volumes than necessary. and not properly disposed of after patients no longer need them. that leads to an oversupply of unneeded drugs and that can be subject to abuse by family members and others. so in order to reduce the volume of unused opioids in the market, this bill will direct the food and drug administration to work with manufacturers to establish programs for the efficient return or destruction of unused schedule two or three opioids. in addition, this bill will facilitate utilization of packaging that may reduce overprescribing, diversion or abuse of opioids. and finally, the bill will require the g.a.o. to study new and innovative technologies that claim to be able to dispose of opioids and other unused medications safely. this bill takes several targeted steps to minimize the amount of unused opioids on the market and i encourage my

colleagues to support its passage and i would yield such time as he may consume to the gentleman from north carolina, one of the authors of this important legislation, mr. hudson. the speaker pro tempore: the gentleman from north carolina is recognized. housing and urban development thank you, mr. chairman. thank you, moo -- mr. hudson: thank you, mr. chairman, and thank you, mr. speaker, for the time. in 2018, more than two million americans will suffer from addiction to prescription or elicit opioids. as i traveled across my district, i've seen first-hand the devastating effect these drugs can have on families, friends and loved ones. there's no barrier for these drugs. they strike at every level of society and across every geographic region. it touches all of us. in north carolina we have four of the top 25 worst cities of opioid abuse in the country. this truly is the crisis next door. and i'm proud of the collective effort the house of representatives has undertaken in a bipartisan way to address this epidemic. one important piece of this effort is a bipartisan bill i worked on with my colleague, g.k. butterfield. the sound disposal and

packaging act. which will direct the f.d.a. to work with manufacturers to help reduce diversion, overprescribing and overdose. it seemed everyone i talked to had sort of a light bulb go off. so many of us have unused opioids in our medicine cabinets from surgeries, accidents or hospital visits. with 70% of heroin addictions beginning in the medicine cabinet, attacking this oversupply with packaging on the front end and with disposal on the back end was a logical place for me to start. we need to reduce the supply of opioids that find their way out of the medicine cabinet and this legislation is a first step that will do just that. i appreciate the leadership of my friend, g.k. butterfield, for working with me in a bipartisan manner and authoring this bill. i want to thank the leadership of the energy and commerce committee and health subcommittee chairs,man waled be, chairman burgess, ranking members pallone and green, for their partnership and help to make sure this could be a reality today. finally, mr. speaker, i ask unanimous consent to submit into the record this letter from disposal r.x. in support

of h.r. 5687. the speaker pro tempore: without objection. mr. hudson: the sound disposal and packaging act. i urge my colleagues to support this legislation and i yield back to chairman walden. mr. walden: i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from massachusetts is recognized. mr. kennedy: thank you, mr. speaker. i rise to voice my support for h.r. 5687. legislation authored by my colleagues, mr. hudson and mr. butterfield. to provide the f.d.a. with authority to employ the use of packaging and disposal technologies to help mitigate the risk of misuse of opioids. as a result of f.d.a.'s efforts to prevent misuse of opioids, commissioner gottlieb bhans actively exploring how packaging and disposal innovations can reduce the supply of opioids in the market. this included hosting a public workshop in december, to explore how we can harness these technologies in the fight against opioid addiction. and how we can improve the safe use of these products for those patients who rely on them to manage chronic pain every day.

commissioner gottlieb also noted, mr. speaker, that the use of these technologies such as packaging merits consideration through a careful, science-based process, one that i hope we'll continue. the legislation we're considering today builds on this work and grants f.d.a. authority to require packaging and disposal technologies for schedule two and schedule three controlled substances. the reflective level of risk associated with that substance. f.d.a.'s provided with the flexibility to permit a range of options for packaging and disposal technologies, as long as such technologies demonstrate comparable effectiveness. this flexibility will be crucial to reduce barriers to generic entry, one of the concerns that was raised during our committee consideration. and to maintain appropriate patient access to these substances. h.r. 5687 also clarifies that labeling related to the inclusion of packaging or disposal technologies cannot be used as a blocking strategy by

brand manufacturers. if enacted, it is my hope that the f.d.a. will continue to work with stakeholders, including manufacturers, to ensure that generic entry is not impeded by the requirement of packaging or disposal technologies. both brand and generic manufacturers should be held to the same performance outcome of mitigating risk and abuse at a time of rising drug costs, i believe, however, manufacturers should be afforded enough flexibility to pursue cost-effective technologies that will also meet shared goals of safety and the patient community. i also hope that any costs associated with the adoption of packaging or disposal technologies will not be borne by the compliants of these medications. -- clients of these medications. i want to thank mr. hudson and butterfield for their work on this issue. i urge my colleagues to support h.r. 5687. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: mr. speaker, i have no other speakers on this

legislation and encourage my colleagues to support the bill. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the question is, will the house suspend the rules and pass the bill, h.r. 5687. as amended. those in favor say aye. those opposed, no. mr. walden: mr. speaker, on that -- the speaker pro tempore: in the opinion of the chair, 2/3 of those voting having responded in the affirmative -- mr. walden: on that i'd ask for a roll call vote, mr. speaker. the speaker pro tempore: does the gentleman request the yeas and nays? mr. walden: i do. the speaker pro tempore: the yeas and nays are requested. all those in favor of taking this vote by the yeas and nays will rise and remain standing until counted. a sufficient number having arisen, the yeas and nays are ordered. pursuant to clause 8 of rule 20, further proceedings on this uestion will be postponed. for what purpose does the gentleman from oregon seek recognition? mr. walden: mr. speaker, i move the house suspend the rules and pass the bill, h.r. 5796, as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5796. a bill to require the secretary of health and human services to provide grants for eligible

entities to provide technical assistance to outliar prescribers of opioids. the speaker pro tempore: pursuant to the rule, the gentleman from oregon, mr. walden, and the gentleman from massachusetts, mr. kennedy, each will control 20 minutes. the chair recognizes the gentleman from oregon. waled-week-old thank you, mr. speaker. again -- mr. walden: thank you, mr. speaker. again, i ask unanimous consent that all members have five legislative days to revise and extend their remarks and insert extraneous materials in the record on the bill, including the exchange of letters between the committee on energy and commerce and the committee on ways and means. the speaker pro tempore: without objection. mr. walden: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. walden: thank you, mr. speaker. i want to commend my colleague, representative fitzpatrick, who is here on the floor with us today, as well as representative curbelo and representative thompson. they all worked really hard to make this bipartisan legislation a success. h.r. 5796 would establish technical assistance grants to make best practices available to those providers who are identified as opioid prescribing outliars. this bill would establish a means of identifying statistical outliars and then

notifying providers if they are an outlier. in addition, the bill authorizes quality improvement organizations and other grant resip yents to re-- recipients to review prescribing patterns and share educational materials and best practices. this legislation will ensure the best prescribing practices are collinically appropriate for patients and are implemented throughout the medicare program. thank you, mr. speaker. with that i'd recognize one of the authors of this important legislation, the gentleman from pennsylvania, mr. fitzpatrick, for such time as he may consume, to speak on the bill. the speaker pro tempore: the gentleman from pennsylvania is recognized. mr. fitzpatrick: thank you, mr. speaker. thank you, chairman walden. the opioid epidemic is devastating my community in bucks and montgomery counties. i talk to these families every day. as our nation continues to grapple with the deadly effects of the opioid epidemic, it is crucial that we take every step possible to stop prescription medication from falling into the wrong hands.

we need to ensure our medical professionals possess the latest best practices for preventing prescription medication abuse. including non-opioid pain management. that's why i'm proud that the house is considering my reach out act, h.r. 5796. by facilitating outreach to outlier opioid prescribers, the reach out act seeks to educate physicians on their prescribing behaviors, without limiting their ability to give patient care. it will be an effective step toward reducing the amount of unnecessary prescription opioids in communities across the nation. the responsible education achieves care and healthy outcomes for users treatment act, the reach out act, h.r. 576, will direct the center for medicaid and medicare services to work with eligible he entities, including quality improvement organizations, to engage in outreach with prescribers identified as clinical outliars, to share best practices to evaluate their prescribing behavior.

h.r. 5796 would build on the lessons learned from c.m.s. special innovation projects, by spreading best practices for preventing prescription drug abuse. providing outreach and education about non-opioid pain management, and reducing the number of opioids prescribed by outlier prescribers. an outliar prescriber is identified in consultation with professional stakeholders as one who prescrice an excessive number of opioids as compared to others, other prescribers in their medical specialty, or geographic area. . our nation's drug epidemic is a complicated issue and our response must be multifaceted. this means giving providers the tools they need to prevent opioid abuse. i want to thank my colleagues, carlos curbelo, and mike thompson, for their support in authoring this bill and i also want to thank our chairman, greg walden, and his energy and commerce committee for their relentless effort to combat the opioid epidemic across the country. and i urge my colleagues,

democrat and republican alike, to support the passage of our reach out act. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. mr. walden: i'd reserve the balance of my time. the speaker pro tempore: the gentleman from oregon reserves. the gentleman from massachusetts. . mr. kennedy: i rise in support of the reach out act. this bill creates grants for technical education for outliar prescribers of opioids. the recipients of these grants, mr. speaker, will encourage them on best practices for prescribing opioids and provide instruction on how to reduce the number of opioids prescribed in the future. coupled with legislation we consider today that would require notification of outliar prescribers of opioids, this will provide them the tools to return to the appropriate prescribing range to help reduce overprescribing. mr. speaker, i have to say we've just been informed there will be a last-minute change to two of the suspension prints in order to accommodate a request

from the appropriations committee. the minority only received notice of these changes within the last hour. while they appear to be changes that are technical in nature to address the jurisdictional issues, we want to highlight this that's being considered on the floor with such short notice. this is not the way to legislate on such an important topic. my colleague and i have explained some concern about this process and the latest issue reinforces those concerns. we urge the chair and the speaker -- excuse me -- to commit to continuing to work with us on a bipartisan basis to avoid some of these changes in the future. with that said i support this bill, i hope the house will support it as well, and i yield back. the speaker pro tempore: the gentleman from massachusetts yields back his time. the gentleman from oregon. mr. walden: mr. speaker, i just want to thank my colleagues for their bipartisan support of this legislation. we also were just notified of the appropriations flag and we're working out those matters at a higher pay level.

so we appreciate and understand and with that, mr. speaker, i urge passage of this legislation and yield back the alance of my time. the gentleman from oregon yields back his time. the question is will the house suspend the rules and pass h.r. 5796, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 having responded in the affirmative, the rules are suspended, the bill is passed, and without objection, the motion to reconsider is laid on the table. without objection, the title is amended. for what purpose does the gentleman from oregon seek recognition? mr. walden: mr. speaker, i move the house suspend the rules and pass the bill h.r. 5605 as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5605, a bill to amend title 18 of the social security act to provide for an treatment disorder

demonstration program. the speaker pro tempore: pursuant to the rule, the gentleman from oregon, mr. walden, and the gentleman from massachusetts, mr. kennedy, each will control 20 minutes. the chair recognizes the gentleman from oregon. mr. walden: thank you, mr. speaker. i ask unanimous consent that all members may have five legislative days to revise and insert heir remarks and extraneous materials in the record on the bill, including exchange of letters between the committee on energy and commerce and the committee on ways and means. the speaker pro tempore: without objection, so ordered. mr. walden: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman from oregon is recognized for as much time as he wishes to use. mr. walden: thank you, mr. speaker. and i want to commend representatives ruiz and representative clarke, representative mullen. they worked to make this bill a bipartisan success. this would authorize a four-year demonstration project to test new ways to treat opioid use disorder among the medicare population. in addition, this will help the prescribing of controlled substance in medicare by having eprescribing. we have heard from prescribers

who have cut down frude lent abuse by switching to eprescribing but saving time and millions of dollars in the process. these are substantive steps forward. another piece of the puzzle in addressing the opioid crisis and i urge passage of the legislation and i'll reserve the balance of my time, mr. speaker. the speaker pro tempore: the gentleman from oregon reserves his time. the chair recognizes the gentleman from massachusetts, mr. kennedy. mr. kennedy: mr. speaker, thank you. i would yield such time as he may consume to my colleague, mr. ruiz. the speaker pro tempore: the gentleman is recognized for such time as he wishes to use. mr. ruiz: thank you. i rise to support the advancing high quality treatment for opioid use disorders in medicare act. i introduced the bill to give older americans across our nation more access to comprehensive addiction treatment services through medicare. seniors are frequently prescribed opioids to treat chronic illnesses with constant lasting pain issues such as

arthritis and other issues related to their muse could you lahr skeletal system. the -- muscular skeletal system. this makes them at risk for developing a dependency and seniors are more physiologically vulnerable to experience dependency and overdose effects. that's because, as you get older, your fizzology changes making them less -- physiological changes making them prone to depression, the leading cause of opioid-related death. and so when you consider that roughly 1/3 of medicare beneficiaries received an opioid prescription in 2016, with over half a million receiving a high dose, it makes sense that the hospitalization rate related to opioid misuse in patients over 65 has increased by 500%. in the past two decades. despite these heightened risk factors, many seniors still do

not have access to comprehensive, evidence-based treatment under traditional medicare. we cannot leave our seniors behind as we work to address this national crisis. our seniors deserve access to the gold standard of care for treating opioid addiction. it's that simple. my bill, h.r. 5605, the advancing high quality treatment for opioid use disorders in medicare act, will open doors for older americans to get that gold standard of care by strengthening medicare for our seniors. my bill does this by creating an alternative payment model demonstration program through medicare for comprehensive treatment and care programs for opioid misuse disorder and will establish quality measures that reward comprehensive treatment programs that actually produce the best patient outcomes. it works by giving providers and institutions that choose to participate a case management payment which they would use to

provide wrap-around services for medicare beneficiaries. teams with an addiction specialist will also receive a high incentive. seniors participating in this program will receive medication-assisted treatment alongside psychosocial support such as psychotherapy, treatment planning, and appropriate social services. this coordinated care approach is considered the gold standard of care and if we want to successfully address this crisis, we need to ensure that individuals have access to treatments that will result in successful outcomes. i have seen firsthand the importance of this with my own patients in the emergency department. getting medication-assisted treatment is important, and the success that treatment is enhanced if that patient is also participating in psychotherapy and receiving the appropriate social services. that's why this demo is supported by the american society of addiction medicine, the california medical

association, among others. it is critical that all americans, regardless of their age or how much money they make, have access to high-quality comprehensive treatment. my ll will strengthen medicare so we can help seniors address opioid dependence by ensuring they get the care they need. i also want to thank ranking member pallone and chairman walden for their support of this legislation and for our seniors. also included in my bill is h.r. 3528, the every prescription conveyed securely act, introduced by catterin clark from massachusetts, -- katherine clark from massachusetts, and representative mullen, and i want to say this will help reduce fraudulent prescribing. her legistion will direct providers to use electronic prescribing for controlled substance, technology for medicare part d by 2021 to cut down on fraud and overprescribi.

already seven states have implemented this system in an effort to combat this crisis and keep illicit opioids off the streets. according to the department of justice, most fraudulent opioid prescriptions are obtained either through doctor shopping, forged prescriptions or theft, all of whh can be addressed by an effective electron ib prescribing for controlled substance -- electronic prescribing controlled substances system. this will help get illegally obtained opioids off the streets. i call on all members of the house to support this critical legislation, and i reserve the balance of my time. if there's anybody who wants to speak on this matter. the speaker pro tempore: the gentleman from california may not reserve his time. he can yield back to the gentleman from massachusetts. mr. kennedy: the gentleman from massachusetts reserves. the speaker pro tempore: the gentleman from oregon. mr. walden: mr. speaker, we have no other speakers on our side if the gentleman wants to close. mr. kennedy: mr. speaker, i want to say that i think dr.

ruiz has done an extraordinary job on this legislation. i would urge the house to support it. i yield back. the speaker pro tempore: both sides have yielded back, the question is will the house suspend the rules and pass -- mr. walden: yield back the balance of my time, mr. speaker. the speaker pro tempore: that's what i thought. mr. walden: that's what i said, yes. the speaker pro tempore: the question is will the house suspend the rules and pass the bill h.r. 5605, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 having responded in the affirmative, the rules are suspended, the bill is passed, and without objection the motion to reconsider is laid on the table. without objection, the title of hat bill is amended. for what purpose does the gentleman from oregon seek recognition? mr. walden: i ask the house suspend the rules and pass the bill h.r. 5811, as amended. the speaker pro tempore: would the gentleman clarify which amendment -- which bill he's talking about? mr. walden: h.r. 5811, as amended.

the speaker pro tempore: the clerk will report the title of that bill. the clerk: h.r. 5811, a bill to amend the federal food, drug, and cosmetic act with respect to postapproval study requirements for certain controlled substances, and for other purposes. the speaker pro tempore: pursuant to the rule, the gentleman from oregon, mr. walden, and the gentleman from massachusetts, mr. kennedy, will each control 20 minutes. the chair recognizes the gentleman from oregon. mr. walden: thank you, mr. speaker. i ask unanimous consent that all members may have five legislative days to revise and extend their remarks and insert extraneous materials into the record on the bill. the speaker pro tempore: without objection, so ordered. mr. walden: thank you, mr. speaker. i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized for as much time as he wishes to use. mr. walden: thank you, mr. speaker. i want to speak in favor of this bipartisan bill and thank representatives mcnerney and representative griffith for working so hard to advance this important policy. currently, there are limited data on the long-term efficacy of opioids. their increased addictive

tendencies over time and this will enhance the food and drug administration authorities and enforcement tools to ensure timely postmarketing studies for chronically administered opioids. collecting and analyzing data is the best way to make sure that patients and doctors have access to evidence-based treatments. this bill will advance our understanding of the science underlying long-term use of opioids and i encourage members to support this passage. i appreciate the work of our sponsors of this bill, including representative griffith, who would be here with us to speak in favor of this legislation but for traffic congestion on his way back from his district has detained him from getting here as he had previously scheduled. so with that, mr. speaker, i reserve the balance of my time. encourage my colleagues to support the bill. the speaker pro tempore: the gentleman from oregon reserves his time. the gentleman from massachusetts is, mr. kennedy, is recognized. mr. kennedy: thank you, mr.

speaker. mr. speaker, i rise in support of h.r. 5811, the long-term opioid efficacy act of 2018. authored by representatives mcnerney and griffith. despite the prevalent use of opioids today in combating pain, the long-term impacts of opioids and whether or not they are truly the most effective treatment is still fairly unknown. f.d.a. commissioner gottlieb testified before the energy and commerce committee that many opioids have not been studied for chronic administration. further studying could help address certain questions. this includes long-term efficacy of opioids, and whether opioids may contribute to increased addictive tendencies over time. this legislation will help us better understand the long-term impacts of opioids and whether opioids truly are the most effective treatment for chronic pain management by allowing the f.d.a. to require manufacturers of controlled substances such as opioids to conduct postmarket studies to study the effectiveness of these products and whether they pose serious

risk. under current law the f.d.a. has the authority to require postmarket studies relating to the safety considerations of a drug but it does not have explicit authority to do so related to the efficacy of a drug. it's our hope by granting this authority to the f.d.a. we will better understand the long-term impacts of opioids that are chronically administered and encourage more responsible prescribing of opioids moving forward. i urge my colleagues to support this legislation, and i yield back the balance of my time. . the speaker pro tempore: the gentleman yields back the balance of his time. >> mr. speaker, i have no urther speakers and i reserve. the speaker pro tempore: without objection, the gentleman from kentucky will control the time for the majority. and the gentleman now reserves. >> i now reserve. the speaker pro tempore: the gentleman from massachusetts already yielded back. >> so the gentleman from kentucky will yield back. the speaker pro tempore: the question is, will the house suspend the rules, pass the

bill, h.r. 5811, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and, without objection, the motion to reconsider is laid on the table. for what purpose does the gentleman from kentucky seek recognition? >> mr. speaker, i move that the house suspend the rules and pass the bill, h.r. 6042, as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 6042. a bill to amend title 19 of the social security act, to delay the reduction and federal medical assistance percentage for medicaid personal care services, furnished without an electronic verification system, and for other purposes. the speaker pro tempore: pursuant to the rule, the gentleman from kentucky, mr. guthrie, and the gentleman from massachusetts, mr. kennedy, each will control 20 minutes. the chair recognizes the gentleman from kentucky. mr. guthrie: mr. speaker, i ask unanimous consent that all members have five legislative days in which to revise and extend their remarks and include extraneous materials

into the record on the bill. the speaker pro tempore: without objection, so ordered. mr. guthrie: mr. speaker, i yield myself as much time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. guthrie: thank you, mr. speaker. i rise today in support of my bill, h.r. 6042, which will ensure the proper implementation of electronic visit verification system or e.v.v. in state medicaid programs. e.v.v. provides a way to track the delivery of in-home medicaid personal care services to help prevent instances of fraud and abuse and to protect patients ensuring they get the services they are entitled to receive. many frail, disabled or otherwise home-bound patients benefit from and even rely on medicaid personal care services and home health services. yet the department of health and human services office of inspector general, o.i.g., found in recent years that the existing program safeguards at the time were often ineffective. despite the fact that they were

intended to prevent improper payments and to ensure medical necessity, patient safety, and quality care. furthermore, the o.i.g. warned the fraud in this area was on the rise. which endangers vulnerable patients and wastes taxpayer money. e.v.v. systems were developed to protect some of the most vulnerable medicaid recipients. last congress in response to the o.i.g. report, i wrote and included a provision in the bipartisan 21st century cures act, to require state medicaid programs to use e.v.v. to attract all personal -- track all personal carer ises -- services conducted in a patient's home. in the time since the implementation, i have received feedback that more time is needed to implement e.v.v. systems. to make sure they are properly and fully integrating the e.v.v. technology. this year i worked with congresswoman degette and congressman langevin to introduce h.r. 6042, which gives states an extra year to put in place their e.v.v. systems and ensure stakeholder

input. home visits are a critical part of improving quality care to patients. many of whom have disabilities and rely on extra care in their homes. h.r. 6042 will make sure that e.v.v. can be implemented effectively and thanks to the hard work and working with, the bill has changed a little bit, with congresswoman degette, who came to me and we said we want to make sure that we had stakeholder input, that has been included in this version of the bill that is before us now. her diligence in doing that has been very helpful and appreciate her efforts in that. so i urge my colleagues to support this bipartisan bill, to provide a simple fix for the benefit of improved accountability, and patient care in state medicaid programs. i reserve my time. the speaker pro tempore: the gentleman from kentucky reserves his time. the chair recognizes the gentleman from massachusetts. mr. kennedy: mr. speaker, thank you. i appreciate the opportunity to speak on this bill. i would like to yield such time as my colleague, the gentleman from rhode island, may consume, r. langevin, when he is ready.

the speaker pro tempore: the gentleman from rhode island is recognized for as much time as he wishes to use. mr. langevin: thank you, mr. speaker. i want to thank the gentleman from massachusetts for yielding. mr. speaker, i rise in support of h.r. 6042, which will delay the implementation of the medicaid electronic visit verification system requirement by one year and promote stakeholder feedback as part of the implementation. the medicaid e.v.v. system requirement under the landmark 21st century cures act was established to ensure accurate billing and delivery of personal care services in the homes of medicaid beneficiaries. look, we want to make sure that medicaid patients are accurately getting the care that theyed -- that they received and that medicaid is properly billed for those services. and that we do everything possible to ring out fraud out of the system. unfortunately the short implementation period, compounded by a delay in c.m.s.

guidance and a lack of stakeholder input, has presented significant challenges for affected populations. especially seniors and people with disabilities. so i'm pleased to join my colleagues, representative guthrie and representative degette, in supporting this important piece of legislation. and i'm glad to see that representative guthrie's bill largely mirrors the bipartisan, bicameral legislation that i used to introduce this last month. the approach it took to bring this bill to the floor is the same dynamic medicaid beneficiaries, family care givers, personal care and home health providers and other stakeholders are hoping to see from c.m.s. when the agency divines e.v.v. system requirements so, that states can design effective and thoughtful e.v.v. programs. delaying implementation by one year and encouraging input from relevant stakeholders will be paramount to the success of the e.v.v. programs and is a part

of our enduring promise to protect vulnerable populations, people who would otherwise suffer from adverse outcomes should the policy be hastily implemented. so again, mr. speaker, i thank mr. guthrie and congresswoman degette, chairman weldon and ranking member pallone, and, again, all those who had a hand in bringing this bill to the floor today, for the opportunity to join in meeting this important effort. i thank the gentleman from massachusetts for yielding the time. and i'm pleased to yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from massachusetts. mr. kennedy: i just want to commend, mr. speaker, the gentleman from rhode island for all of his work and dedication on this issue and urge the house to pass the bill. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from kentucky. mr. guthrie: mr. speaker, i recognize myself for as much time as i may consume to close. the speaker pro tempore: the gentleman is recognized. mr. guthrie: i didn't see my friend from rhode island on the floor when i was working earlier, ms. degette, in her

work on. this working hard and appreciate my friend from rhode island leading on this issue and us being able to work together and our staffs working together to make something very important like this. his input was very important. i'm prepared to clofmentse urge my colleagues to vote -- close. i urge my colleagues to vote for the bill and i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the question is, will the house suspend the rules, pass the bill, h.r. 6042, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and, without objection, the motion to reconsider is laid on the table. for what purpose does the gentleman from kentucky seek recognition? mr. guthrie: mr. speaker, i move that the house suspend the rules and pass the bill, h.r. 5801, as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5801. a bill to amend title xix of the social security act, to

provide for requirements under the medicaid program relating to the use of qualified prescription drug monitoring programs and prescribing certain controlled substances. the speaker pro tempore: pursuant to the rule, the gentleman from kentucky, mr. guthrie, and the gentleman from massachusetts, mr. kennedy, each will control 20 minutes. the chair recognizes the gentleman from kentucky, mr. guthrie. mr. guthrie: thank you, mr. speaker. i ask unanimous consent that all members have five legislative days in which to revise and extend their remarks and insert extraneous materials in the record on the bill. the speaker pro tempore: without objection, so ordered. mr. guthrie: mr. speaker, i yield myself -- myself as much time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. guthrie: thank you, mr. speaker. this bill, co-sponsored by myself, representative griffith, representative fitzpatrick, representative blackburn, requires covered medicaid providers to check the prescription drug history of a beneficiary through a qualified prescription drug monitoring program or pdmp, before prescribing a scheduled two controlled substance. this is a crucial step in helping us get a grip on the

crisis we are facing. currently 49 states have a pdmp program and the final state, missouri, has begun to work to create a pdmp program. however, only 13 states require the prescribers check the patients' prescribing history prior to prescribing controlled substances, despite the fact that studies show that mandatory pdmp access laws are effective in reducing prescription drug abuse and in particular opioid abuse. for example, from new york, evidence from new york suggests that pdmp's are associated with a 75% decrease in the number of beneficiaries who got a prescription drug for more than one prescribing and dispenser. implementation of florida's pdmp was associated with a 25% decrease in the mortality related to oxycodone. both the current past administrations -- current and past administrations have noticed that they are most effect whve they are used by all clinicians. this bill requires that states have a qualified pdmp by

october 1, 2021, and provides enhanced federal matching funds father from fiscal year 2018 -- funds from fiscal year 2018 to 2021, for states to share data with bordering states. how states and covered providers can use pdmp's to reduce the abuse of controlled substances. medicaid patients are especially vulnerable to the opioid epidemic. this bill is an important step and one that i believe will help us address the scourge that is the opioid crisis. my thanks to morgyn griffith, whose leadership on this issue has been invaluable. thank you, mr. speaker, and i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from massachusetts is recognized. mr. kennedy: thank you, mr. speaker. mr. speaker, i rise to speak on hmple r. 5801, the medicaid partnership act. this legislation requires medicaid providers to have a program that requires providers

to check a qualified prescription drug monitoring program, a pdmp, before prescribing schedule two controlled substance and it encourages integration of pdmp's into the work flow. today, mr. speaker, more than 30 states have some form of mandated provider pdmp check. this legislation would require all medicaid programs to have such a policy in place. integrating pdmp's with medicaid is a critical tool for this crisis, for our providers to be able to prevent opioids and addiction. research has demonstrated that these types of mandates can encourage registration and the use of a state's pdmp by providers. that is why i support investing in our pdmp's, so they're good, real-time systems that our providers can check easily. importantly, this legislation preserves the ability of states to work with providers to design a mandate that best meets the needs of all involved. state flexibility and proper financing of our pdmp's is critical to achieving the

intent of this legislation. which, if enacted, will closely monitor going forward. thank you, mr. speaker. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from kentucky is recognized. mr. guthrie: mr. speaker, i have no further speakers and am prepared to close. i yield back the balance of my time. the speaker pro tempore: i encourage -- mr. guthrie: i encourage my colleagues to vote for this bill and i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the question is, will the house suspend the rules and pass h.r. 5801, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and, without objection the motion to reconsider is laid on the table. for what purpose does the gentleman from kentucky seek recognition? mr. guthrie: mr. speaker, i move that the house suspend the rules and pass the bill, h.r. 5590, as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: union calendar number 580.

h.r. 5590. a bill to require the secretary of health and human services to provide for an action plan on recommendations for changes under medicare and medicaid, to prevent opioid addictions and enhance access to medication assisted treatment and for other purposes. the speaker pro tempore: pursuant to the rule, the gentleman from kentucky, mr. guthrie, and the gentleman from massachusetts, mr. kennedy, will each control 20 minutes. the chair recognizes the gentleman from kentucky. mr. guthrie: thank you ks mr. speaker. i ask unanimous -- thank you, mr. speaker. i ask unanimous consent that all members may have five legislative days in which to revise and extend their remarks and insert extraneous materials on the record -- in the record on the bill. including an exchange of letters between the kess are committee of -- between the committee of energy and commerce and the committee of ways and means. the speaker pro tempore: without objection. mr. guthrie: mr. speaker, i yield myself as much time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. guthrie: thank you, mr. speaker. i want to commend

representative representatives kinsering, clarke, lahood and davis. h.r. 5590 requires the department of health and human services to develop an opioid addiction plan to evaluate what h.h.s. is doing across the department, to address the opioid crisis and how it can be improved. this action plan will include an evaluation of coverage and reimbursement rates for non-opioid pain treatments, the potential role of medical devices in addressing this crisis, and the availability of treatment for rural anded mically underserved communities, among other components. in addition, medicare and medicaid are on the front lines of this epidemic and we need to be sure that they are not creating adverse incentives that can harm beneficiaries with coverage and reimbursement decisions. addressed in this bill will provide a review of how c.m.s. can continue to fight this national crisis. i urge my colleagues to support

and pass this bipartisan bill. i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. and the gentleman from massachusetts is recognized. mr. kennedy: thank you, mr. speaker. 5590. in support of h.r. i commend their hard work on this legislation. we know there is more that the department of homeland security needs to do to -- department of health and human services needs to do to address the opioid crisis. we need to bring down opioid prescribing and have medication assisted treatment for opioid providers -- excuse me -- disorders. h.r. 5590 will direct the secretary of h.h.d. to respond to the opioid crisis -- h.h.s. to respond to the opioid crisis and look at barriers to both use of nonopioid medication to monitor pain as well as therapies that treatment opioid addiction. while this is an important

bill, i want to say it is incremental. i want to reiterate my continuing concern while democrats support working on a legislative package to address the opioid crisis, as we have over the course of the day today and over the cost of the past several weeks with our republican colleagues, we must also assure that we first do no harm. the trump administration and republicans' efforts to dismantle the affordable care act will do serious harm to our health care system and to individuals suffering from opioid use disorders, specifically. for instance, the trump administration continues to undermine the individual market by promoting junk insurance plans. these plans would allow insurers to once again exclude individuals with pre-existing conditions, such as opioid use disorder, and charge individuals more based on their health status. it would make coverage for individuals who need comprehensive coverage such as individuals with opioid use disorders less affordable and less accessible.

moreover, republicans are not done with their efforts to repeal the a.c.a. despite public backlash to repeal last year, and expressing concern of the opioid crisis, news reports indicates they are going to try to repeal the affordable care act. the opioids package cannot be considered in a vuge. ongoing efforts to sabotage and reveal the a.c.a. will not only reverse the gains we make today but inflict harm in our health care system and our inability to fight the opioid crisis. mr. speaker, i thank you and i reserve. the speaker pro tempore: the gentleman reserves. the gentleman from kentucky is recognized. mr. guthrie: mr. speaker, i have no further speakers. am prepared to close. the speaker pro tempore: the gentleman from massachusetts is recognized. mr. kennedy: i yield back. the speaker pro tempore: the gentleman from kentucky . mr. guthrie: thank you, mr. speaker. i yield back. the speaker pro tempore: the gentleman yields back. the question is will the house suspend the rules and pass h.r. 5590, as amended. those in favor say aye. those opposed, no.

in the opinion of the chair, 2/3 having responded in the affirmative, the rules are suspended, the bill is passed, and without objection the motion to reconsider is laid on the table.

the speaker pro tempore: for

what purpose does the gentlewoman from indiana seek recognition? mrs. walorski: mr. speaker, i move the house suspend the rules and pass h.r. 6110, the dr. todd graham pain management treatment and recovery act of 2018. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 61 10, a bill to amend title 18 of the social security act to provide for the review and adjustments of payments under the medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of nonopioid alternative treatments, and for other purposes. the speaker pro tempore: pursuant to the rule, the gentlewoman from indiana, mrs. walorski, and the gentlewoman from california, ms. chu, will each control 20 minutes. the chair recognizes the gentlewoman from indiana. mrs. walorski: mr. speaker, i ask unanimous consent that all members may have five legislative days to revise and extend their remarks and include extraneous material on h.r. 6110, currently under consideration. the speaker pro tempore: without objection. mrs. walorski: mr. speaker, i

ask unanimous consent to enter to the record an exchange of letters between the committee on ways and means and the committee of energy and commerce. the speaker pro tempore: without objection. mrs. walorski: i rise in upport of h.r. 6110, the dr. todd graham pain management and treatment act, solving the opioid epidemic requires everyone working together, from the federal government down to those fighting on the front lines of the fight. treatment l have options that are nonoippeds. it contains the following provision that will be vital in overcoming this crisis. h.r. 5578, the promoting outpatient access to nonopioid treatment act, introduced by kenny marchant and sander levin which requires the secretary of

health and human services, or h.h.s., to require payments made to hospital outpatient departments and ambulatory surgery services to make sure there is no financial incentive to use opioids over nonopioid alternatives. h.r. -- a bill provides payments to federally qualified health centers and rural health clinics to offset the cost of their providers receiving training so they're able to provide medication assisted treatment that will help individuals recover from opioid use disorder. and h.r. 5725, the benefit evaluation of safe treatment act, introduced by health subcommittee chairman peter roskam and representatives linda sanchez, john shimkus and raul ruiz which will evaluate the extent to which inmate plans offer medication assisted treatments and cover nonopioid alternative treatments not otherwise covered under

medicare fee for service as part of a supplemental benefit. h.r. 5790, the medicare and nurse hotline act, introduced by representatives kristi noem and judy chu, which directs the secretary of h.h.s. to educate patients on the availability of psychologist services and explore the use of hotlines to reduce unnecessary hospitalizations in medicare. the bill is named after my friend, dr. todd graham. he was a double board certified physician in both physical medicine, rehabilitation and pain medicine who lived and worked in my district in northern indiana. last year he was senselessly murdered after refusing to prescribe an opioid to a patient. dr. graham prided himself on serving his patients in a friendly and caring fashion. he treated each person individually, taking the time to offer specific steps to treat their issues. one day last year, he had an interaction with a patient demanding opioids. a situation that's becoming

disturbingly all too common. he refused to write a prescription for her but her husband, who was also there, became increasingly angry throughout that visit. two hours later they left his office, the husband returned and murdered him in cold blood. dr. graham's loss has been a heavy blow but his legacy of compassion and enthusiasm lives on through his wife julie, their two daughters and their son who plans to follow in his father's footsteps. we're lucky to have the graham family with us here today to witness the passage of this important bill. mr. speaker, i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves. the gentlewoman from california is recognized. ms. chu: i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized. ms. chu: mr. speaker, according to the centers for disease control and prevention, more than 42,000 americans died from opioid related drug overdoses in 2016. that's five times more than the overdose rate in 1999.

and as we heard from countless numbers -- members in this chamber there is no congressional district that hasn't been impacted by the opioid crisis. no town or city is immune from the devastating impact of addiction. my hope that the steps we take today are the first of many to address the needs of our communities. the substance abuse and mental health services administration, our samhsa, estimated that in 2016, 11.8 million americans over the age of 12 had misused opioids in the past year. and 3.8 million were currently misusing prescription pain relievers. but while we have seen news reports of the devastating toll this crisis is taking on our nation's young people, it's important to note that our seniors are also suffering. from 2005 to 2014, individuals 65 years and older experienced an 85% cumulative increase in

opioid-related in-patient stays and a 112% cumulative increase of emergency department visits, the largest increase of any age group. compared to other age groups, individuals 65 and older have the highest rate of opioid-related in-patient stays in 13 states, including my home state of california. and this crisis is especially acute for the nonelderly mecare population. in 2015, nonelderly medicare beneficiaries, or those who qualify on the basis of disability, have opioid utilization rates more than twice that of elderly beneficiaries. 6110, before us, h.r. the most act, contains numerous provisions aimed at improving access to treatment for medicare beneficiaries suffering from opioid use disorders, including access to nondrug opioid alternatives. while every alternative will not work for every person, when

dealing with a crisis of this magnitude, i believe that we must use every tool in the toolbox. this bill contains two bipartisan provisions i authored with my colleagues on the ways and means committee. i first like to thank the gentlelady from indiana, ms. walorski, for working -- mrs. with a walorski, for working with me on language to expand patient access to nondrug alternatives for opioids in chronic care settings. studies conducted by the n.i.h. have concluded that alternative treatments like acupuncture can be effective in treating conditions like chronic pain. this issue is very important to me because i've been working to expand access to acupuncture so i first arrived in the california state legislature many years ago. and i've heard firsthand what a difference acupuncture can make in the lives of patients. i remember very clearly when i heard the testimony of a woman who had severe back pain but

did not want invasive surgery and risk possible addiction to morphine. instead, she sought acupuncture and it worked for her and she avoided the risks associated with surgey and certain pain medicaon -- surgery and certain pain medication. furthermore, we know occupational therapy helps alleviate the need for opioid prescription. by asking c.m.s. to exam this, we can open the door for more treatment alternatives for beneficiaries. i'm also proud that this bill includes a provision i authored with the gentlelady from north dakota, mrs. noem, to address the need for more psychologists in the medicare program. this bill will direct the center for medicare and medicaid innovation to exam ways for beneficiaries to familiarize themselves with coverage for psychologists services and request a study from the government accountability office on the

viability of mental and behavioral health services in the medicare program. . as one of only two psychologists in congress, i believe that expanding access to psychologist services in medicare is one of the most important things we can do to improve the mental health of our senior population. we know that those who suffer from depression or other mental health disorders are particularly vulnerable to addiction. and for those who have already taken the incredibly difficult step of seeking treatment we need to ensure that they have access to the full range of mental health professionals who can support them on the journey to recovery. h.r. 6110 also contains a number of provisions from my colleagues on the ways and means committee. congress members levin and marchant authored a provision to review certain medicare payments in outpatient settings to determine whether there are financial incentives in the medicare program to use or prescribe opioids instead of

evidence-based non-opioid alternatives. next, the legislation includes a provision introduced by congress member sanchez and roskam, which would direct the secretary of h.h.s. to evaluate the extent to which medicare advantage programs offer medication-assisted treatment or m.a.t. and cover non-opioid alternative treatments. not otherwise covered under a traditional medicare as part of a supplemental benefit. finally, this bill would also include a provision from congress member danny davis and rothfus, which would also provide grants to federally qualified centers and rural health clinics to help yaufer set the cost of training -- offset the cost of training providers to become certified in dispensing medications for opioid abuse dependence. while the provisions in the bills before us this afternoon will certainly move us in the right direction, we cannot stop here. for example, the medicaid program pays for the majority

of mental health and subsnce abuse treatments in this country. and yet we see multiple attempts by republicans over the past four years to slash this program. we must maintain protections for those with pre-existing conditions so that those who sought treatment for their addiction disorders are not nished for trying to get sober. and we must maintain the progress we've made with the affordable care act and work together to bring down the premiums for american families so that should they need coverage for mental health counseling osubstance abuse treatment, no one is shut out because of how much money they make or what state they live in. so i hope that today represents the first step, and i hope my colleagues on the other side of t aisle will continue work with uso invest in pre invention, treatmentand recovery efforts all across the country. i encourage my colleagues to support this legislation and i reserve the balance of my time.

the speaker pro tempore: the gentlewoman reserves the balance of her time. the gentlewoman from indiana is recognized. mrs. walorski: i have no other speakers. i reserve. the speaker pro tempore: the gentlewoman reserves the balance of her time. the gentlewoman from california is recognized. yield : mr. speaker, i myself as much time as i may consume. the speaker pro tempore: you are recognized. ms. chu: mr. speaker, i'm encouraged to see my colleagues on the other side of the aisle turn their attention to this criticalssue, but this is not a new problem. and the coverage expansions under the affordable care ac have been among the most significant steps the federal government has taken to stem the tide of the opioid crisis. and yet republicans in congress and president trump have actively worked to repeal this landmark law. the medicaid expansion and the increased coverage under the individual market have provided millions of americans access to heth insurance and research has shown that medicaid pansion states have seen a

greater reduction in deaths from opioids than nonexpansi states. and again, medicaid is the biggest pair for -- payer for substance use disorder treatment in this untry. we simply can't afford to go back. as we discuss this cris today and in the week to come, we must broadenur uerstanding of the ways in which we as a tion approach chronic pain. and that is exactly what h.r. 6110 does. while there will always be patients who have a legitimate need for these medications, we need to look beyond a system where an opioid to prescription is the automatic default. this means we needo look to alternative methods of treating pain. whether it be acupuncture or physical therapy or a medical device. it means we must examine existing policies that may have inadvertently incentived opioidrescribing practices.

but as much as we look forward, we mst also address the crisis in front of us. so i'm thrilled to see provisions in this bill that would study medicare advantage plans already doing groundbreaking work in substance abuse disorder treatment. i'm also glad to see that this bill provides direct resources to the frontlines in the form of grants for federally qualified health centers to provide additional training for our providers. i hope that in the future we will work to expand access to alternatives, both within the medicare program and in the broader population. and ensure that no matter where someone lives or what kind of insurance coverage they have, they are able to seek treatment. i urge my colleagues to support h.r. 6110, and i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back the balance of her time. the gentlewoman from indiana is recognized. mrs. walorski: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized.

mrs. walorski: thank you, mr. speaker. this epidemic knows no boundaries. opioid abuse continues to devastate families and communities all over this country. as we continue to work toward commonsense solutions to the opioid epidemic, this bipartisan legislation will help break down bear yers to nonopioid treatments and give health care providers better tools to prevent addiction and to assist in recovery. i want to thank chairman brady for all of his hard work, as well as my friend, ms. chu of california, who helped develop and introduce this bill. i urge my colleagues to support this bill and i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back the balance of her time. the question is, will the house suspend the rules and pass h.r. 6110. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and, without objection, the motion to reconsider is laid on the table.

for what purpose does the gentlewoman from indiana seek recognition? mrs. walorski: mr. speaker, i move that the house suspend the rules and pass h.r. 5774, the combating opioid abuse for care n hospitals act of 2018. the speaker pro tempore: does the gentlewoman wish to call up the bill as amended? mrs. walorski: yes. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5774, a bill to require the secretary of health and human services to develop guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part a of the medicare program, provide for opioid quality measures development and provide for a technical expert panel on reducing surgical setting, opioid use and data collection on perioperative use and for other purposes.

the speaker pro tempore: pursuant to the rule, the gentlewoman from indiana, mrs. walorski, and the gentlewoman from california, ms. chu, each will control 20 minutes. the chair recognizes the gentlewoman from indiana. mrs. walorski: mr. speaker, i ask unanimous consent that all members may have five legislative days within which to revise and extend their remarks and include extraneous material on h.r. 5774, currently under consideration. the speaker pro tempore: without objection. mrs. walorski: mr. speaker, i ask unanimous consent to enter into the record an exchange of letters between the committee of ways and means and the committee on energy and commerce. the speaker pro tempore: without objection. mrs. walorski: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized. mrs. walorski: thank you, mr. speaker. i rise today in strong support of h.r. 5774, the combating opioid abuse for care in hospitals act of 2018, or coach act. we have learned that across the continuum of care, screening for opioid abuse disorder and education for patients and providers is necessary to help eradicate this epidemic. this legislation includes efforts to develop quality measures related to the

treatment of individuals with opioid use disorder, to improve and publicize guidance on opioid prescribing, and to develop expert recommendations on reducing the use of opioids in a surgical setting. these provisions champ beyond by representatives paulsen, nny davis, higgins, buchanan --, lamb and smith, will help make sure of care. the coach act also includes h.r. 5699, the hospital opioid solutions tool kit, which representative curbelo introduced with congresswoman kuster. the tool kit, to be able made available the center for medicaid and medicaid servicesings, or c.m.s., will contain resources that hospitals can use to ensure the best practices are being utilized for educatinging patients and providers about treatment for pain management. including the development of a notification template for hospital staff to better inform

patients prescribed opioids of potential risks. i'm thankful for all the hard work on this legislation by members of both side of the aisle. especially representative curbo, delbene, bud and kuster. i would also like to thank chairman brady for his leadership as well as the house ways and means committee staff for their efforts. i encourage all of my colleagues to vote in favor of this, h.r. 5774, the combating opioid abuse for care in hospitals act of 2018. this is an issue that effects every congressional district. it's imperative that we find solutions to get people into treatment and provide opioid abuse on the front end. mr. speaker, i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves. the gentlewoman from california is recognized. ms. chu: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized. ms. chu: mr. speaker, i offer my support for h.r. 5774, the coach act, which was introduced by congress members delbene and curbelo. this bill focuses specifically on provider education and would

require the centers for medicaid and medicare services to develop a tool kit that provides best practices to hospitals for reducing opioid use. every year approximately 51 million americans undergo in-patient surgery each year and 80% of those patients receive opioids to treat postsurgical pain after a low-risk surgery. this is an alarming number, as study haves -- studies have found thaten an opioid predescription at discharge is a risk factor for chronic opioid use. according to the national institute on drug abuse, approximately 10% of patients who are prescribed opioids for long-term use develop an opioid use disorder. this was the case with my constituent, ryan hampton, who was a promising young college student when he broke his knee in a hike accident and received an opioid prescription at discharge. ryan fell hard into addiction, eventually turning to heroin,

and becoming homeless. while ryan has beat the odds and is now a national advocate for those in recovery from addiction, many are not so lucky. so it's with people like ryan in mind that i support this bill today. we should be giving our providers every tool possible to help them battle the opioid crisis and hopefully change behavior in such a way as to limit unnecessary opioid prescriptions. i urge my colleagues to support this bill and i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves the balance of her time. the gentlewoman from indiana is recognized. mrs. walorski: having no other speakers, i reserve, mr. speaker. the speaker pro tempore: the gentlewoman reserves the balance of her time. the gentlewoman from california is recognized. ms. chu: mr. speaker, i have no other speakers and i am prepared to close. in my district, the los angeles county department of public health substance abuse prevention and control program has worked with hospitals, city and providers to develop a five-year strategic plan to address the opioid crisis in

our country. we know that not every hospital has the resources or ability to develop such a plan. by providing a centralized tool kit available to all hospitals under resource providers will have the best access to best practices that have helped communities bat the opioid epidemic -- combat the opioid epidemic with so many individuals first experiencing opioids via a hospital procedure, it's critical that we give our providers every resource they need to make the best medical decisions for their patients while reducing the number of opioid prescriptions overall. i urge my colleagues to support this bill and i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back the balance of her time. the gentlewoman from indiana is recognized. mrs. walorski: mr. speaker, i yield myself such time as i may dume -- consume. the speaker pro tempore: the gentlewoman is recognized. mrs. walorski: mr. speaker, in closing i want to remind my colleagues why it's so important that we continue working to solve this crisis. thousands of lives have already been lost because of

opioid-related drug overdoses. tragically indiana has been hit especially hard by this crisis. this is a public health emergency and our response must be comprehensive and swift. i am proud of the coach act, bipartisan legislation that would help prevent opioid misuse and reduce dependence on opioids for pain management. i urge all of my colleagues to support it. mr. speaker, i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back the balance of her time. the question is, will the house suspend the rules and pass the bill, h.r. 5774, as amended. those in favor say aye. those opposed, no. who. -- those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and, without objection the motion to reconsider is laid on the table.

for what purpose does the gentleman from florida seek recognition? >> mr. speaker, i move the house suspend the rules and pass h.r. 5775, the providing reliable options for patients and educational resources, proper, act of 2018. the speaker pro tempore: the clerk will report the title of the bill. does the gentleman move to suspend the rules and pass the bill, as amended? mr. curbelo: i do. the speaker pro tempore: the clerk will report the title of the bill the clerk: union calendar number 594, h.r. 5775, a bill to amend title 18 of the social security act to require medicare advantage plans and part d prescription drug plans to include information on the risks associated with opioids, coverage of certain nonopioid treatments used to treat pain and on the safe disposable of prescription drugs and for other purposes. the speaker pro tempore: pursuant to the rule, the

gentleman from florida, mr. curbelo, and the gentlewoman from california, ms. chu, each will control 20 minutes. the chair recognizes the gentleman from florida. mr. curbelo: mr. speaker, i ask unanimous consent that all members may have five legislative days to revise and extend their remarks and include extraneous materials on h.r. 5774, currently under consideration. the speaker pro tempore: without objection. mr. curbelo: mr. speaker, i ask unanimous consent to enter into the record an exchange of letters between the committee on ways and means and the committee of energy and commerce. the speaker pro tempore: without objection. mr. curbelo: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. curbelo: i stand in strong support of h.r. 5775, the providing reliable options for patients and educational resources act, or the proper act. this is a bipartisan bill centered on increasesing educationle resources for -- educational resources for medicare beneficiaries. h.r. 5775, introduced by my colleagues erik paulsen, ron

kind, brian fitzpatrick, bruce poliquin, and connor lamb, has several bills to combat the opioid crisis, including h.r. 5686, the medicare choice act, h.r. 5714, the education for disposal of unused opioids act, and h.r. 5719, the reduce overprescribing opioids in treatment, or root act. unfortunately, my home state of florida has seen a dramatic increase in opioid-related opioid deaths the past several years. every year thousands of floridians become addicted and lose their lives to opioid addiction. effective alternatives to opioids such as physical therapy and medical devices exist and in most instances are covered by medicare. however, many seniors and providers simply aren't aware of the coverage options. education is a key tool for seniors to make infor what purpose does decisions about their health care. for this reason, the ways and

means committee sprang into action and passed h.r. 5775 unanimously. this bill contains provisions authored by my colleagues erik paulsen and ron kind to inform seniors about alternative nonaddictive pain management therapies covered by medicare. this bill also includes a provision led by diane black, ruiz on safe ul disposal of unused controlled substances. this includes another provision led by diane black and tom o'halleran to remove all pain-related questions contained in medicare's hospital patient surveys unless the individual experiencing the pain is also informed about the risks associated with the use of opioids and given information on nonopioid alternatives for the treatment of pain. i want to thank my colleagues for their strong bipartisan work. this bill will make a difference in addressing the

opioid epidemic that continues to devastate many americans and their families. madam speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman from florida reserves. the gentlelady from california is recognized. ms. chu: madam speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized. ms. chu: madam speaker, i offer my support of h.r. 5775, the proper act. this bill, introduced by my colleagues representatives paulsen and kind, would require medicare advantage and medicare part d plans to provide information to beneficiaries on the risks associated with prolonged opioid use as well as coverage information about alternatives like nonfarm could logical therapies, device -- nonpharmacological therapies, devices. it's important that our hospitals and outpatient settings have up-to-date and accurate information about

opioid use. but it's equally critical this information is provided to beneficiaries. additionally, providing information on alternative therapies could help beneficiaries who want to try a nonopioid pain management therapy to do so. thus avoiding a prescription where it may not be necessary. this bill also requires that by january 1, 2019, all pain-related questions be removed from the hospital consumer assessment of health care providers and systems surveys with some exceptions. if hospitals are graded on how much pain patients are feeling, they likely would seek to minimize pain -- the patient's pain through pain management drugs like opioids. in order to properly address this crisis in the medicare program, we must ensure that beneficiaries have the information necessary to make informed decisions about their

pain management plan. i urge my colleagues to support this bill and i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves. the gentleman from florida is recognized. mr. curbelo: having no speakers, i reserve, madam speaker. the speaker pro tempore: the gentleman reserves. the gentlewoman from california. ms. chu: madam speaker, i have no other speakers, and i'm prepared to close. the speaker pro tempore: the gentlewoman is recognized. ms. chu: just as we are working to improve provider education, we must not leave our medicare beneficiaries behind. i support this bill because it would ensure that medicare advantage and medicare part d plans provide their beneficiaries with information on the risks of prolonged opioid use as well as information about coverage for alternatives for pain management. earlier in this debate, i mentioned a woman who testified that although she was experiencing severe back pain, she did not want to risk taking addictive pain medication and instead turned to acupuncture.

it worked for her and she told me because of her aki puncture treatment she was able -- acupuncture treatment she was able to live pain free. this means that alternatives will not work for every patient, but we should give patients the ability to choose their own pain management therapy. i believe that h.r. 5775 is an important step toward this goal. i urge my colleagues to support this bill and i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields. the gentleman from florida is recognized. mr. curbelo: thank you, madam speaker. the proper act will bring much-needed education to our seniors. this bill is brought through the committee process in a bipartisan fashion. now on the floor i strongly urge my colleagues on both sides of the aisle to vote in favor of h.r. 5775, the proper act. this is another example of how republicans and democrats can come together, can work together to help struggling families in our country. in this case, seniors who

should be aware of all the different options that are available to them for pain treatment and should certainly be aware of the many risks associated with opioid use. so i'm grateful to all my colleagues and to committee staff for all their work on this legislation. and i strongly support everyone to support it. i strongly encourage everyone to support it. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the question is will the house suspend the rules and pass the amended. 5775, as those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 having responded in the affirmative, the rules are suspended, the bill is passed, and without objection the motion to reconsider is laid on the table.

for what purpose does the gentleman from illinois seek recognition? mr. roskam: i ask unanimous consent that the house suspend the rules and pass the bill h.r. 5775. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5775, a bill to amend title 18 of the social security act to require medicare prescription drug plans to establish drug management programs for at-risk beneficiaries, require electronic prior authorization for covered part d drugs, and to provide for other program integrity measures under parts c and d of the medicare program. the speaker pro tempore: pursuant to the rule, the gentleman from illinois, mr. roskam, and the gentlewoman from california, ms. chu, will each control 20 minutes. the chair recognizes the gentleman from illinois. mr. roskam: mr. speaker, i ask -- madam speaker, i ask unanimous consent that all members may have five legislative days to revise and

extend their remarks and include extraneous material on h.r. 5773, currently under consideration. the speaker pro tempore: without objection. mr. roskam: madam speaker, i yield myself such time as i may consume. i stand in strong support of bipartisan bill curbing opioid use by increasing resources for beneficiaries to help ensure they're properly adhering to their prescribed pain medications. my home state of illinois is experiencing a notable increase in opioid-related overdose deaths. according to the illinois department of public health, there has been a 44.3% increase in drug overdoses from 2013 to 2016. this staggering statistic is not limited to my district alone. this crisis has affected all of our districts, and for some, the four walls of our own homes. for this reason, congress is taking action today to continue our work to deliver solutions

for the opioid epidemic that's plaguing far too many american families. h.r. 5773, which i introduced with my colleagues, representatives knight, sewell, sinema, packages several previously introduced bills. h.r. 5773 includes policies under my bill, h.r. 5716, the commit to opioid medical prescriber accountability and safety for seniors act, otherwise known as the compass act, very deuced with representative larson, to make sure that prescribers are prescribing. oper and the stabilizing electronic prior authorization for safe prescribing act, led by representatives schweikert and mike thompson, to standardize electronic prior authorization to reduce physician burden and ensure medically necessary

access to drugs like opioids that have dangerous side effects and high risk of abuse. and third, this bill contains policies from h.r. 5715, the strengthening partnerships to prevent opioid abuse act, led by representatives renacci and sewell, that will establish a portal to better facilitate communication between plan sponsors and the medicare program to prevent opioid overuse and overprescribing. and finally, the bill contains policies from h.r. 5684, the protecting seniors from opioid abuse act, championed by my colleagues, mr. kelly of pennsylvania, again, mr. thompson of california, which expands medication therapy management services to those who are at risk of opioid overuse. i look forward to working with my colleagues to advance policies like all the bills we have today that will further prevent opioid overuse and overprescribing. madam speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentlewoman from california is recognized. ms. chu: madam speaker, i yield

myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized. ms. chu: madam speaker, i'm pleased to support h.r. 5773, the pass act, introduced by congress members sewell and roskam. this bill focuses on policies to help medicare plans prevent -- d misuse without misuse. h.r. 5773 requires medicare prescription drug plans establish mandatory lock-in programs for seniors who are at risk for opioid overuse. these programs curb fraud, abuse, and misuse of prescribed medications while at the same time ensuring that seniors who have legitimate need of these medications can access them. for example, these prevents doctor and pharmacy shopping medical nt dupela tiff

therapy that will develop drug overuse. and it will help those be eligible for the medicare medication program. this will help them understand medication and how they are working together and allows pharmacists or other health professionals to give beneficiaries a comprehensive review of all of their medications and talk to them about any interactions, risks, or side effects. this bill also includes a provision that would streamline the electronic prior authorization system, which is meant to ensure that certain drugs are covered by an insurer before the drug is dispense the pass act also includes a provision introduced by representatives sewell and renacci that streamlines communications between the center for medicare and medicaid services and medicare part c and

d plans regarding program integrity. finally, h.r. 5773 would direct the secretary of the department of health and human services to annually notify medicare part d prescribers who are identified as outlier prescribers compared to their colleagues in their specialty and region. this has certain exclusions. for example, patients receiving hospice care, but will be used to help prescribers who may not realize that they are an outlier to reevaluate their practices and make adjustments before any harm is done. i encourage my colleagues to support this legislation and i eserve the balance of my time. mr. roskam: i yield three minutes to the gentleman from pell, mr. kelly.

the speaker pro tempore: the gentleman is recognized. mr. kelly: mr. roskam, thank you so much for your time. this opioid epidemic is kaling 116 people of all ages every day. it is horribly impacting western pennsylvania families and communities there isn't a silver bullet to end the suffering. it's going to take communities working together to treat addiction and find lasting methods of prevention. i'm proud of the work we have done in the people's house to put forward quality, bipartisan solutions to provide better alternatives and treatment for all americans. i want to thank chairman roskam for including my legislation h.r. 5684, the protecting seniors from opioid abuse act into this package. this bipartisan bill with my colleagues mr. thompson, mrs. mcmorris rodgers and mr. coyle -- mr. doyle will help at-risk seniors manage medications and avoid prescription drug use. this bill gives seniors who are at risk for prescription abuse access to the medication, they

are -- medication therapy management program. this successful program allows seniors to sit down with a pharmacist or other health professional and receive expert advice on how to best manage their prescriptions. i think for most of us, when you go to pick up your prescriptions, oftentimes you're asking do you want us to sit down and go over this with you, often time there's a line behind you, or you can just check the box and pick up your prescription. that's not the answer to what we're trying to do. with the med case therapy management program we sit down with the seniors and explain the interaction between some of the drugs they're taking and some of the drug that was been prescribed to them. it's critical they have access to this informing. the center for medicare and medicaid services has confirmed that this approach works. to reduce opioid overuse and avoid dangerous drug interactions, expanding access to medicare therapy management for at-risk beneficialaries will ensure that these serious drugs

are used properly before it's too late. this epidemic is devastating our nation's communities and families. i hope we can't to work together as a unified congress to fight this deadly crisis. i appreciate the chairman's time and i urge support of this bill and i yield back. the speaker pro tempore: the gentleman yields. the gentlewoman from california is recognize. ms. chu: madam speaker, i have no other speakers and am prepared to close. the speaker pro tempore: the gentlewoman is recognized. ms. chu: our country is truly facing a crisis when it comes to opioids and the medicare population isn't immune from this we must be careful in our approach and ensure that the policies we enact in congress don't leave out those who have legitimate medical need for these medications like those with cancer, those in hospice or those with genetic conditions like sickle cell disease. h.r. 5773 is a modest step in the right direction. and i look forward to continuing to work with my colleagues on ways to address the opioid

crisis within the medicare program. i urge my colleagues to support this bill. i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields. the gentleman is recognized. mr. roskam: thank you, madam speaker. i spent a lot of time, as i know we all have, in listening in my own constituency the west and northwest suburbs of chicago. i've listened to physicians, police chiefs, care givers and others and i've heard a common them. -- theme. the common theme is we need legislation that encourages use of alternative treatment, that increases provider education and assists with detection of those who are at risk. the prevention -- the preventing ddiction and susceptible seniors pass act will do this. i thank my colleagues for coming together to offer this solution. i would also like to thank our colleagues on the energy and commerce committee for their commitment to working on this, particularly my counterpart who

chairs the subcommittee, dr. burgess and chairman walden as well. this bill was brought through the committee process in a bipartisan fashion and now on the floor i strongly urge my colleagues on both sides of the aisle to vote in favor of h.r. 5773, the pass act, prevent overuse and overprescribing in the medicare program. i yield back the balance of my time. the speaker pro tempore: the question is, will the house suspend the rules and pass the bill h.r. 5773 as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 being in the affirmative, the rules are suspended, the bill is passed and without objection the motion to reconsider is laid on the table. without objection the title amended. -- the title is amended. for what purpose does the gentleman from illinois seek recognition? mr. roskam: i move that the house suspend the rules and pass h.r. 5676, the stop excessive

narcotics in our retirement communities act of 2018 as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5676, a bill to amend title 18 of the social security act to authorize suspension of payments by medicare prescription drug plans and mapd plans pending investigations of credible allegations of fraud by pharmacies. the speaker pro tempore: pursuant to the rule, the gentleman from illinois, mr. roskam, and the gentlewoman from california, ms. chu, each will control 20 minutes. the chair recognizes the gentleman from illinois. mr. roskam: i ask unanimous consent that all members may have five legislate -- legislative days to revise and extend their remarks and include extraneous material on h.r. 5676 currently under consideration. the speaker pro tempore: without objection. mr. roskam: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. roskam: i stand in strong support of h.r. 5676 a

bipartisan bill centered on protecting medsare beneficiaries from abusive opioid prescribing while ensuring appropriate access to medically necessary medications. this bill strikes a balance which we need. h.r. 5676 introduced by our lleague mr. macarthur, mr. schweikert, mr. tonko, ms. kuster, extends existing authority in the medicare fee for service program to medicare precipitation drug plans. according to a recent report released by the department of heath and -- health and human services, one third of medicare beneficiaries received an opioid prescription from 2016, costing the program $4.1 billion and represent as many as 79.4 million prescriptions. the report found as many as half a million part d beneficiaries received high ams of opioids

with almost 70,000 receiving extreme amounts of opioids, many of them as a result of doctor shopping. for years, medicare fee for service program has been able to suspend payments to a provider or supplier pebbeding an investigation of a credible allegation of fraud against the provide ore supplier. extending this authority to the medicare advantage and prescription drug plan will help bridge the gap in care beneficiaries and halt the fraudulent activity that contributes to the opioid crisis. i'd like to thank the colleagues on both sides of the aislen the ways and means committee for their commitment to work cooperatively on this and also our colleagues in the -- on the energy and commerce committee, particularly congressman burgess who chairs the health subcommittee and also chairman walden. they played a role in laying the groundwork for policies like this that crack down on abusers.

i look forward to continuing to work on this issue, on both sides of the aisle, and with the administration on policies that will further strengthen the integrity of the medicare program. mr. speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. for what purpose does the gentlewoman from california seek recognition? ms. chu: i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized. ms. chu: i'm pleased to support the senior communities protection act this eaffordable care act granted the department of health and human service it is the -- the authority to suspend payments to medicare part a and b providers pending investigationings into credible allegations of fraud or abuse. the seniors communities protection act would dwant that same authority to medicare part d plans. this bill would only allow plans to suspend these payments if doing so would not cause an cess or network adequacy

problem for the beneficiaries served by the pharmacy. it would give medicare an additional tool to help crack down on bad actors who put seniors at risk. for example, this can help plans and medicare crack down on the practice of pill dumping where a small pharmacy receives millions of opioid pills from a distributor that far exceeds the population of patients it serves. in one case, it was found that a single small town pharmacy received the equivalent of more than 9,000 pills perez dent over the course of a decade. in another case, opioid distributor shipped nine million 406 to a town of residents, an average of 7,000

pill pers year. congressional investigations have revealed that distributors did not perform sufficient oversight of these shipments. as our communities are flooded with these drugs, it's important that medicare plans have the ability to stop the bad actors when they are identified. i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves. the gentleman from illinois. mr. roskam: i want to go into a little more detail and focus in on how it is that we're here today and why we're all -- why there's an urgency to this. the gentlelady mentioned some staggering statistics, 9,000 pills per individual over a decade in a particular town. it tells you that a system has gotten entirely out of balance. there's a lot of explanations and there's not a lot of clean hands. we know that there have been government policy that was driven in part the opioid crisis by evol waiting providers on

whether or not pain satisfaction has been completed at the patient side of things. we know that in some cases there have been health care providers that have not gone into the detail of getting to the root of a problem. we know that we as a culture put extraordinary pressure on health care providers when we tell them we want them to help us get out of pain and when we do that, sometimes, mr. speaker, unfortunately, we put ourselves at risk and we know that pharma has a lot to answer for. all those things we know are true. i think what is encouraging to me is this idea of people coming together on both sides and recognizing, we don't have to live this way anymore. we don't have to have a system that drives people in this direction. let me just go back to this inspector genre port from the department of health and human services that is that 79 million prescriptions involving opioids were prescribed in 2015 alone. that is a staggering number.

and i think that if we are diligent, if we were forward thinking and if we continue to work together, both sides of the aisle coming together, mr. speaker, i think that in 10 years, our country will be having a different conversation on opioids. it may take that long but i think in 10 years' time, if we do the work if we're committed to this, we can look back and we say that was a time when the united states came together around a public health crisis. that was a time when people had a general understanding that they needed to get over sort of the normal approaches on things. and that was a time that people came together with holistic approaches. and toward that end, i reserve the balance of my time the speaker pro tempore: the gentleman reserves. for what purpose does the gentleman from -- does the gentlewoman from california seek recognition? ms. chu: i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves. the gentleman is recognized mr. roskam: i yield three

minutes to the gentleman from new jersey, mr. mcarthu. the speaker pro tempore: the gentleman is recognized. of macarthur: as co-chair the bipartisan heroin task force, i spend a lot of my time working on this opioid crisis. congress must do everything we can to ensure that our communities have the resources for prevention, treatment, and enforcement. my district is also home to 140,000 seniors. among the highest in the country. as we work together in a bipartisan way to fight this epidemic, we cannot forget about our seniors and how this crisis affects them. more than 42 million americans get their prescription drugs through medicare. they rely on medicare part d, the prescription drug program, for the drugs that they need. . a 2017 report by the office of

inspector general found that 500,000 medicare part d beneficiaries received high amounts of opioids. high means in excess of what he manufacturer and c.d.c. recommends. in other words, dangerous amounts. too many senior communities are being flooded with opioids. we must protect our seniors and that means we must protect medicare from those who would abuse it. we must fight the fraudulent abuse of medicare by people who do not have seniors' best interests at heart. seniors are having their medicare numbers stolen and then used to fraudulently bill medicare for opioids. so-called pill dumping has resulted in millions of painkillers flooding small towns across the country through just a few pharmacies. much of it paid for by medicare. last year, the department of justice announced the biggest health care fraud bust in its

history. they arrested 412 defendants for billing the government $1.2 billion in fraudulent charges, including prescription opioids, which were then distributed in our communities. senior protection -- the senior communities protection act gives medicare a new tool to crack down on those who would fraudulently use senior medicare dollars to flood communities with unneeded drugs. the bill gives medicare part d plan sponsors the ability to suspend payments to a pharmacy that is under investigation due to a credible allegation of fraud or abuse. this should make it easier to respond to harmful fraud and abusive activity more quickly. this protects medicare dollars for those for whom they are intended forks for our seniors. if the criminal is fraudulently billing medicare and distributing prescription drugs, medicare should not have to pay for it while an investigation is under way. those dollars are for seniors.

this is the same tool available to other programs in medicare, and this bill simply extends it to the prescription drug program. it's a good and smart tool. it's designed to make sure seniors keep getting the drugs they do need while protecting pharmacies that have done nothing wrong. i urge adoption. another 30 seconds. mr. roskam: i yield another minute. ms. macarthur: it will protect -- mr. mac art are: it will pro-- mr. macarthur: it will protect the pharmacies who have done nothing wrong. i would like to mention the bipartisan members that lent their support to it, representatives chris collins, david schweikert and kuster, earl blumenauer and paul tonko. i urge support of this bill and

i yield back. thank you. the speaker pro tempore: the gentleman reserves -- yields. mr. roskam: i reserve. the speaker pro tempore: for what purpose does the gentlewoman from california seek recognition? ms. chu: mr. speaker, i have no other speakers at this time and i am prepared to close. a 2017 report from the office of the inspector general of the department of health and human services found that about 70,000 so seniors on medicare received prescriptions for what the report described as an extreme amount of opioids during a single year. that means these seniors were receiving 2.5 times the level the centers for disease control recommends for patients with chronic pain. another 22,000 beneficiaries were identified as doctor shopping which means that they received a high number of opioids from multiple prescribers and pharmacies. the opioid crisis is not exclusive to young people. that same o.i.g. report found

1/3 of medicare part d beneficiaries received an opioid prescription in 2016 which is about 79.4 prescriptions. 79.4 million prescriptions. while there are certainly individuals who have a legitimate need for these drugs, h.r. 5676 will help medicare part d plans crack down on the bad actors who are flooding our communities with excessive opioid pills. i urge my colleagues to support this bill, and i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields. for what purpose does the gentleman from illinois seek recognition? mr. roskam: to close, mr. speaker. mr. speaker, in a nutshell, i think the gentlelady from california put it well. what she was arguing was this bill strikes a balance which it does. it is designed to focus our time and our attention and our energies to making sure that the bad actors are weeded out, that the abuse is stopped, and that we can bring balance to

the system. the stop excessive narcotics in our retirement communities protection act is another step in this direction to protect our nation's seniors. it was brought to the floor, that is this bill, through a bipartisan committee process, and i urge its passage. i yield back the balance of my time. the speaker pro tempore: the gentleman yields. the question is will the house suspend the rules and pass h.r. 5676, as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 having responded in the affirmative -- mr. roskam: i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. all those in favor of taking this vote by the yeas and nays will rise will rise and remain standing until counted -- nays will rise and remain standing until counted. a sufficient number having arisen, the yeas and nays are ordered.

pursuant to clause 8 of rule 20, further proceedings on this question will be postponed. for what purpose does the gentleman from illinois seek recognition? mr. roskam: mr. speaker, i move the house suspend the rules and expanding 723, the oversight of opioid prescribing and payment act of 2018, as amended. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 5723, a bill to require the medicare payment advisory commission to report on opioid payment, adverse incentives, and data under the medicare program. the speaker pro tempore: pursuant to the rule, the gentleman from illinois, mr. roskam, and the gentlewoman from california, ms. chu, will each control 20 minutes. the chair recognizes the gentleman from illinois. mr. roskam: mr. speaker, i ask unanimous consent that all members may have five legislative days to revise and extend their remarks and include extraneous material on h.r. 5723, currently under consideration. the speaker pro tempore: without objection. mr. roskam: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized.

mr. roskam: mr. speaker, i rise today in support of h.r. 5723, the expanding oversight of opioid prescribing and payment act of 2018 sponsored by my colleague, representative tenney, along with representatives mckinley and delbene. it is the result of work by members and staff on both sides of the aisle, and i'm pleased to have taken part in these important efforts to address the opioid epidemic. this legislation responds to a crucial recommendation from the commission on combating drug addiction and the opioid crisis by directing the medicare ayment advisory commission, or medpac, to help prescribers reduce patients from overdose. the report will take a close look at these financial incentives while also examining the use of data to track and monitor opioid use to more fully understand opioid

utilization patterns in medicare so we may cultivate bet remember solutions to combat the epidemic itself. medpac may also make recommendations to address perverse incentives in medicare's payment systems that may encourage opioid overprescribing. mr. speaker, i encourage awful my colleagues to vote in favor of h.r. 5723, the expanding oversight of opioid prescribing and payment act of 2018. opioids took the lives of 42,000 americans in 2016, and the issue affects countless families in illinois and in my congressional district and i know that's true all across the country. the legislation brings us one step closer to providing our communities and families with the tools necessary to combat the epidemic. i reserve the balance of my time. the speaker pro tempore: the gentleman from illinois reserves. for what purpose does the gentlewoman from california seek recognition? ms. chu: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentlewoman is recognized.

ms. chu: i'm pleased to support h.r. 5723, the expanding oversight of opioid prescribing and payment act. as i mentioned earlier, 80% of low-risk surgery patients receive an opioid prescription to treat their postsurgical pain. these prescriptions are certainly necessary for many patients, but with such a high percentage, we must examine if medicare payment policies are ultimately discouraging the use of nonopioid alternatives. this bill, introduced by represent tiffs susan delbene and claudia tenney, would require the medicare payment advisory commission to submit a report to congress dealing how medicare reimburses pain management treatments in a hospital setting. this report will also examine what incentives exists in the in-patient prospective payment system and outpatient prospective payment system for overprescribing and how

prescribing data is tracked and monitored in medicare claims. this crisis was not created in a vacuum and it will take all efforts to find a solution, including examining how our hospital payment policies have pushed providers towards prescribing such adisketive medications. i support h.r. -- addictive medications. i support h.r. 5723, and efforts to determine which policies within medicare, if any, have contributed to this opioid epidemic. i am also strongly supportive of the directive within this report to realign payment policies to increase access to nonopioid alternatives for pain management. i reserve the balance of my time. the speaker pro tempore: the gentlewoman reserves. the gentleman from illinois. mr. roskam: mr. speaker, i yield five minutes to the gentlelady from new york, ms. tenney. the speaker pro tempore: the gentlelady is recognized for five minutes. ms. tenney: thank you, mr. speaker. thank you, mr. chairman. and i want to thank the gentleman for yielding so much time for me in favor of this

legislation that i co-authored with my colleague, ms. delbene, on this bipartisan piece. h.r. 5723, the expanding oversight of opioid prescribing and payment act of 2018. mr. speaker, in my district and across the nation, the opioid epidemic has ravaged communities, torn apart families and ruined everyday americans. opioid abuse and drug-related deaths are rising. in my district it rose over 350% in the short period between 2012 and 2016. each day i continue to hear from families across the 22nd district who have been impacted by this epidemic. they share deeply moving and personal stories of loss and struggle and they always urge me that more needs to be done. mr. speaker, they are right. this is why the people's house is taking significant bipartisan action to pass record funding for addiction treatment and prevention and to stop the flow of illicit drugs comes across the borders. this is not the time to let up.

during an opioid roundtable i held in my district, i heard from members of the community to -- who told me that opioid is the only option after a complicated surgery or procedure as routine as a root canal. it's backed up by the hard truth in 2016 there were 66.5 opioid prescriptions per 100 people. mr. speaker, that amounts to more than 214 million total opioid prescriptions. the expanding oversight of opioid prescribing and payment act seeks to find out what is fueling these prescriptions. this bipartisan bill requires that medicare payment advisory committee, medpac, to research and identify adverse incentives in the medicare and medicaid programs that lead to an overprescription of opioids versus readily available nonopioid alternatives. medicare and other insurance providers often do not cover nonopioid alternatives for pain, and this legislation seeks to understand why. once we're able to understand the cause, we can change

medicare policy to reduce demand for opioids to address chronic pain and provide patients with a safer, nonaddictive, nonopioid alternative for pain. opioid overdose is now the leading cause of death for americans under 50. we must take action. mr. speaker, combating this epidemic starts by eliminating any incentives that cause our constituents to become addicted to opioids and other prescription drugs in the first place. i want to thank my colleagues, ms. delbene, mr. mckinley, mr. sanford for joining me in this bipartisan effort and appreciate the work of chairman brady and every member of the ways and means committee who worked to help to get us this far. i want to thank a special thank you to representative roskam from illinois, for providing the opportunity to speak on this important legislation. i yield back the balance of my time and ask that my colleagues support this legislation. thank you. the speaker pro tempore: the gentlewoman yields. ms. chu: i reserve the balance of my time. the speaker pro tempore: the gentlelady from california.

ms. chu: i reserve the balance of my time. the speaker pro tempore: the gentlelady reserves. mr. roskam: i think we are prepared to close. if the gentlelady will close and we can wind it up. the speaker pro tempore: the gentlelady from california. ms. chu: mr. speaker, i have no other speakers and i am prepared to close. i must reiterate that while i support the efforts of this exam o direct medpac to doing to -- we need to dedicate resources to fix it. we need to ngs in long-term treatment programs and comp rehence i programs that provide safe house, peer support and other support. while we should examine the policies that brought us to this crisis in the first place, we need to do more to find long lasting solutions. i implore my colleagues today to ensure this package of bills is not the end of the discussion. i hope to see more hearings,

more proposals, more testimony from experts on how we can enact federal policies that will save lives. i hope that instead of attacking our existing health care system, republicans work with democrats to improve the affordable care act, increase access to coverage, work to bring down premiums, and invest in the public health of our nation. addiction is a disease, not a choice. i look forward to working with my colleagues from both sides of the aisle to eradicate this disease from our community. i urge my colleagues to support this bill and i yield back the balance of my time. the speaker pro tempore: the gentlelady yields. the gentleman from illinois. mr. roskam: thank you, mr. speaker. i think ms. ten nee's argument a -- ms. tenney's argument a minute soog smart, and measured and the way we should go. if there are incentives that are misaligned let's understand

those. let's absorb them and change them. it should no -- it should not be that there's a financial incentive to offer an opioid or for an opioid to get into a system as opposed to a nonopioid alternative. so for sure we need to study this. we need to have a clear understanding. i'd like to thank the members on both sides of the aisle for the work they did as well as chairman brady for his leadership in moving this through the ways and means committee and it's such an important time with 115 deaths from opioid overdoses every day, everyone knows that time is not our friend. there's an urgency to this. we have to have a clear understand og of what's going on. it's imperative that we identify current practices that prevent the use of nonopioid treatments for pain mkt and that we reduce financial incentives that have unintentionally led to overprescriptions. i urge my colleagues to support this bill and i yield back the balance of my time. the speaker pro tempore: the

gentleman yields. the question is, will the house suspend the rules and pass the bill h.r. 5723 as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 being in the affirmative, the rules are suspended, the bill is passed, and without objection, the motion to reconsider is laid on the table. r what purpose does the -- pursuant to clause 12-a of rule 1, the chair declares the house in recess for a period of less than 15 minutes.

twelltwell for decades we've offered c-span to our customers because we believe in the network mission to open, to unfiltered, trusted media resource. and we proudly support c-span's

effort to help inform and educate the nation on policy, politics, history and current events. g.c.i. and the cable companies around the nation make c-span possible. there's no government mandate, there's no public funding. >> we'll take you back live now to the house floor for more debate on opioid legislation. estaishhe naal uan security chno laborato a forerurpo the spea pursuant to the rule, theke gentleman from new york, mr. donovan and the gentleman from rhode island mr. langevin each will control 20 minutes. the chair recognizes the gentleman from new york. mr. donovan: i ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous materials on the bill under consideration. the speaker pro tempore: without objection. mr. donovan: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized.