House Subcommittee Approves Opioid Package

Kerry Dooley Young

April 26, 2018

A House panel on Wednesday evening approved a wide-ranging set of proposals intended to address the nation's opioid crisis, including a plan to offer loan repayment of as much as $250,000 for healthcare professionals willing to work in regions hard hit by substance abuse.

The House Energy and Commerce Health Subcommittee advanced a mix of bills and less developed proposals, called discussion drafts, regarding prevention and treatment of substance abuse. The panel also considered an animal health bill, bringing the tally of bills and drafts readied for consideration by the full Energy and Commerce Committee to 57.

The bills and discussions drafts proposed tweaks to prescribing rules for opioids as well as new initiatives and directions for Medicare, Medicaid, and the US Food and Drug Administration.  Substance abuse remains a top priority for lawmakers in both parties, even as federal agencies implement the Comprehensive Addiction and Recovery Act (CARA) of 2016. On average about 115 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC).

"This is not an abstract fight against an unknown enemy; this is personal — because it is a battle for the heart and soul of too many of our friends, neighbors, and communities," said Rep. Michael C. Burgess, MD (R-TX), the chairman of the Energy and Commerce health subcommittee, at the meeting to consider and amend the legislation.

Most of the proposals considered on Wednesday had bipartisan support, increasing the odds of Congress clearing opioids legislation this year. The Senate Health, Education, Labor and Pensions Committee on Tuesday approved its own package, with an intent of getting it on the floor for a vote this summer. Energy and Commerce Chairman Greg Walden (R-OR) said he intends to have his committee's legislation on the House floor by Memorial Day.

The Energy and Commerce health subcommittee approved 13 measures as a group on what's known as en bloc consideration. These included the Substance Use Disorder Workforce Loan Repayment Act, which would offer participants as much as $250,000 in aid. The bill intends to encourage physicians and other healthcare professionals to spend 6 years working in regions where the drug overdose rates run higher than the national average, as measured by data from the CDC.

Creating such a loan repayment program would aid public health even beyond addressing the need for substance abuse treatment, said the Infectious Diseases Society of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society in a joint letter supporting this bill.

The burden of debt from medical school is one of the reasons some physicians opt not to pursue careers fighting infectious diseases and addressing public health epidemics, the groups said.

"Your legislation comes at an essential time and could play a crucial role in helping to support more healthcare providers in pursuing careers in infectious diseases and HIV as well as bolstering the substance use treatment provider workforce in addition to attracting these health care providers to shortage areas where they are urgently needed," the three groups wrote in a March 29 letter.

Other Measures

Also in the en bloc group of legislative proposals was a bill that seeks to standardize electronic prior authorization under Medicare Part D drugs plans. Another measure in this group would support for efforts to improve how health professionals are taught about substance abuse and pain.

The subcommittee also approved another 35 measures by individual bipartisan voice votes. These included a plan to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. Another bill would add a pain assessment to the Welcome to Medicare initial examinations and provide for discussion in these visits of alternatives to opioids.

Other measures approved would do the following:

  • Create a demonstration project for an Alternative Payment Model for treating substance abuse; 

  • Evaluate use of telehealth services in treating opioid use disorder;

  • Require e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program; and

  • Aid hospitals in developing protocols regarding naloxone for discharging patients who have presented with an opioid overdose.

The subcommittee approved another nine measures on roll-call votes, with Democrats often objecting. These included a measure intended to make Medicaid programs have state-determined limitations  for opioid refills and monitor concurrent prescribing of opioids and other drugs, such as benzodiazepines and antipsychotics.

Burgess noted that some of the proposals considered Wednesday remained in their early stages, known as discussion draft forms, in order to allow further debate. But Democrats objected in many cases that the proposals needed more work and were not ready yet to be approved. 

Rep. Frank Pallone Jr of New Jersey, the ranking Democrat on the House Energy and Commerce Committee, said many of the discussion drafts remained "half baked." Many of the measures still needed more input from the federal agencies involved as well as analysis by the Congressional Budget Office, he said.

"We can all agree that action must be taken to stymie the opioid overdose deaths ravaging our country, but taking the wrong action because we are not spending the appropriate amount of time to get these policies right could have the very serious consequence of making things far worse," Pallone said.

Pallone also stressed that there had not yet been a discussion about paying for the costs of the proposed new initiatives and program changes. Lawmakers often need to take money from other federal programs to offset budget increases for more favored ones and to pay the costs of new initiatives.

"The reality is that meaningful policy in this space may cost money, and agreement on appropriate offsets that do not harm people — including the very people that we may be trying to help — is a critical component needed in order for me to support these bills moving forward," Pallone said.

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