H.R. 4063 — what changed
Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act
From Reported in House to Engrossed in House. 1 section amended, 5 added, and 14 removed between Reported in House and Engrossed in House.
Section 1 Short title
added This Act may be cited as the “Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act” or the “Jason Simcakoski PROMISE Act”.
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Short title— This Act may be cited as the “Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act” or the “Jason Simcakoski PROMISE Act”.
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Table of contents— The table of contents for this Act is as follows:
Sec. 101 Establishment of Advisory Committee to review guidelines on management of opioid therapy by Department of Veterans Affairs and Department of Defense
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Advisory Committee— Not later than 120 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly convene an advisory committee to—
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conduct a thorough review of the most recent VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain; and
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make recommendations to the Secretaries with respect to updating the Clinical Practice Guideline.
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Matters included— In conducting the review under subsection (a)(1), the Advisory Committee shall examine whether the Clinical Practical Guideline should include the following:
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Enhanced guidance with respect to—
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the coadministration of an opioid and other drugs, including benzodiazepines, that may result in life-limiting drug interactions;
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the treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide; and
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the use of opioid therapy to treat mental health disorders other than opioid use disorder.
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Enhanced guidance with respect to the treatment of patients with behaviors or comorbidities, such as post-traumatic stress disorder or other psychiatric disorders, or a history of substance abuse or addiction, that requires a consultation or comanagement of opioid therapy with one or more specialists in pain management, mental health, or addictions.
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Enhanced guidance with respect to health care providers—
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conducting an effective assessment for patients beginning or continuing opioid therapy, including understanding and setting realistic goals with respect to achieving and maintaining an expected level of pain relief, improved function, or a clinically appropriate combination of both; and
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effectively assessing whether opioid therapy is achieving or maintaining the established treatment goals of the patient or whether the patient and health care provider should discuss adjusting, augmenting , or discontinuing the opioid therapy.
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Guidance that each health care provider of the Department of Veterans Affairs and the Department of Defense, before initiating opioid therapy to treat a patient as part of the comprehensive assessment conducted by the health care provider, use the Opioid Therapy Risk Report tool of the Department of Veterans Affairs (or similar monitoring tool), which shall include information from the prescription drug monitoring program of each State that includes the most recent information to date relating to the patient that accessed such program to assess the risk for adverse outcomes of opioid therapy for the patient, including the concurrent use of controlled substances such as benzodiazepines, as part of the comprehensive assessment conducted by the health care provider.
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Guidelines to govern the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to taper opioid therapy when adjusting or discontinuing the use of opioid therapy.
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Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition between inpatient and outpatient health care settings, which may include the use of care transition plans.
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Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition from receiving care during active duty to post-military health care networks.
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Enhanced standards with respect to the use of routine and random urine drug tests for all patients before and during opioid therapy to help prevent substance abuse, dependence, and diversion, including—
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that such tests occur not less frequently than once each year; and
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that health care providers appropriately order, interpret and respond to the results from such tests to tailor pain therapy, safeguards, and risk management strategies to each patient.
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Guidance that health care providers discuss with patients, before initiating opioid therapy, options for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence.
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Guidance for health care providers with respect to evidence-based non-opioid treatments within the Department of Veterans Affairs and the Department of Defense, including medical devices and other therapies approved or cleared by the Food and Drug Administration for the treatment of chronic pain as an alternative to or to augment opioid therapy.
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Consultation— In carrying out the review under paragraph (1) of subsection (a), and before making the recommendations under paragraph (2) of such subsection, the Advisory Committee shall consult with the VA/DOD Management of Opioid Therapy for Chronic Pain Working Group.
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Submission— Not later than one year after the date of the enactment of this Act, the Advisory Committee shall submit to the Secretaries the review and recommendations described in subsection (a)(1).
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Application of Federal Advisory Committee Act— The provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Advisory Committee.
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Definitions— In this section:
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The term “Advisory Committee” means the advisory committee established under subsection (a).
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The term “Clinical Practice Guideline” means the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.
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The term “controlled substance” has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
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The term “State” means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Sec. 102 Improvement of opioid safety measures by Department of Veterans Affairs
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Expansion of opioid safety initiative— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall expand the Opioid Safety Initiative of the Department of Veterans Affairs to include all medical facilities of the Department.
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Pain management education and training—
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In general— In carrying out the Opioid Safety Initiative of the Department, the Secretary shall require all employees of the Department responsible for prescribing opioids to receive education and training described in paragraph (2).
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Education and training— Education and training described in this paragraph is education and training on pain management and safe opioid prescribing practices for purposes of safely and effectively managing patients with chronic pain, including education and training on the following:
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The implementation of and full compliance with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline.
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The use of evidence-based pain management therapies, including cognitive-behavioral therapy, non-opioid alternatives, and non-drug methods and procedures to managing pain and related health conditions including medical devices approved or cleared by the Food and Drug Administration for the treatment of patients with chronic pain and complementary alternative medicines.
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Screening and identification of patients with substance use disorder, including drug-seeking behavior, before prescribing opioids, assessment of risk potential for patients developing an addiction, and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected.
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Communication with patients on the potential harm associated with the use of opioids and other controlled substances, including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances.
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Such other education and training as the Secretary considers appropriate to ensure that veterans receive safe and high-quality pain management care from the Department.
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Use of existing program— In providing education and training described in paragraph (2), the Secretary shall use the Interdisciplinary Chronic Pain Management Training Team Program of the Department (or success program).
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Pain management teams—
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In general— In carrying out the Opioid Safety Initiative of the Department, the director of each medical facility of the Department shall identify and designate a pain management team of health care professionals, which may include board certified pain medicine specialists, responsible for coordinating and overseeing pain management therapy at such facility for patients experiencing acute and chronic pain that is non-cancer related.
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Establishment of protocols—
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In general— In consultation with the Directors of each Veterans Integrated Service Network, the Secretary shall establish standard protocols for the designation of pain management teams at each medical facility within the Department.
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Consultation on prescription of opioids— Each protocol established under subparagraph (A) shall ensure that any health care provider without expertise in prescribing analgesics or who has not completed the education and training under subsection (b), including a mental health care provider, does not prescribe opioids to a patient unless that health care provider—
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consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and
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refers the patient to the pain management team for any subsequent prescriptions and related therapy.
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Report—
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In general— Not later than one year after the date of enactment of this Act, the director of each medical facility of the Department shall submit to the Under Secretary for Health and the director of the Veterans Integrated Service Network in which the medical facility is located a report identifying the health care professionals that have been designated as members of the pain management team at the medical facility pursuant to paragraph (1).
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Elements— Each report submitted under subparagraph (A) with respect to a medical facility of the Department shall include—
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a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection (b);
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a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is non-cancer related; and
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a certification as to whether the medical facility—
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fully complies with the stepped-care model of pain management and other pain management policies contained in Directive 2009-053 of the Veterans Health Administration, or successor directive; or
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does not fully comply with such stepped-care model of pain management and other pain management policies but is carrying out a corrective plan of action to ensure such full compliance.
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Tracking and monitoring of opioid use—
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Prescription drug monitoring programs of states— In carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool of the Department, the Secretary shall—
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ensure access by health care providers of the Department to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the Department through the prescription drug monitoring program of each State with such a program, including by seeking to enter into memoranda of understanding with States to allow shared access of such information between States and the Department;
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include such information in the Opioid Therapy Risk Report; and
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require health care providers of the Department to submit to the prescription drug monitoring program of each State information on prescriptions of controlled substances received by veterans in that State under the laws administered by the Secretary.
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Report on tracking of data on opioid use— Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the feasibility and advisability of improving the Opioid Therapy Risk Report tool of the Department to allow for more advanced real-time tracking of and access to data on—
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the key clinical indicators with respect to the totality of opioid use by veterans;
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concurrent prescribing by health care providers of the Department of opioids in different health care settings, including data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder; and
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mail-order prescriptions of opioid prescribed to veterans under the laws administered by the Secretary.
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Availability of opioid receptor antagonists—
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Increased availability and use—
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In general— The Secretary shall maximize the availability of opioid receptor antagonists approved by the Food and Drug Administration, including naloxone, to veterans.
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Availability, training, and distributing— In carrying out subparagraph (A), not later than 90 days after the date of the enactment of this Act, the Secretary shall—
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equip each pharmacy of the Department with opioid receptor antagonists approved by the Food and Drug Administration to be dispensed to outpatients as needed; and
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expand the Overdose Education and Naloxone Distribution program of the Department to ensure that all veterans in receipt of health care under laws administered by the Secretary who are at risk of opioid overdose may access such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists.
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Veterans who are at risk— For purposes of subparagraph (B), veterans who are at risk of opioid overdose include—
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veterans receiving long-term opioid therapy;
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veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and
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veterans who are at risk as determined by a health care provider who is treating the veteran.
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Report— Not later than 120 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on carrying out paragraph (1), including an assessment of any remaining steps to be carried out by the Secretary to carry out such paragraph.
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Inclusion of certain information and capabilities in opioid therapy risk report tool of the Department—
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Information— The Secretary shall include in the Opioid Therapy Risk Report tool of the Department—
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information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and
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information on the results of the most recent urine drug test for each veteran.
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Capabilities— The Secretary shall include in the Opioid Therapy Risk Report tool the ability of the health care providers of the Department to determine whether a health care provider of the Department prescribed opioids to a veteran without checking the information in the tool with respect to the veteran.
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Notifications of risk in computerized health record— The Secretary shall modify the computerized patient record system of the Department to ensure that any health care provider that accesses the record of a veteran, regardless of the reason the veteran seeks care from the health care provider, will be immediately notified whether the veteran—
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is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose;
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has a history of opioid abuse; or
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is at risk of becoming an opioid abuser as determined by a health care provider who is treating the veteran.
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Definitions— In this section:
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The term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
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The term State means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Sec. 103 Strengthening of joint working group on pain management of the Department of Veterans Affairs and the Department of Defense
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In general— Not later than 90 days after the date of enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the Pain Management Working Group of the Health Executive Committee of the Department of Veterans Affairs–Department of Defense Joint Executive Committee established under section 320 of title 38, United States Code, includes a focus on the following:
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The opioid prescribing practices of health care providers of each Department.
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The ability of each Department to manage acute and chronic pain among individuals receiving health care from the Department, including training health care providers with respect to pain management.
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The use by each Department of complementary and integrative health and complementary alternative medicines in treating such individuals.
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The concurrent use by health care providers of each Department of opioids and prescription drugs to treat mental health disorders, including benzodiazepines.
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The practice by health care providers of each Department of prescribing opioids to treat mental health disorders.
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The coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from the Department of Defense to receiving health care from the Department of Veterans Affairs.
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The ability of each Department to identify and treat substance use disorders among individuals receiving health care from that Department.
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Coordination and consultation— The Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the working group described in subsection (a)—
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coordinates the activities of the working group with other relevant working groups established under section 320 of title 38, United States Code, including the working groups on evidence-based practice, patient safety, pharmacy, psychological health, and psychological health;
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consults with other relevant Federal agencies, including the Centers for Disease Control and Prevention, with respect to the activities of the working group; and
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consults with the Department of Veterans Affairs and the Department of Defense with respect to, reviews, and comments on the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, or any successor guideline, before any update to the guideline is released.
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Consultations— The Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the working group described in subsection (a) is able to meaningfully consult with respect to the updated guideline required under subsection (a) of section 101, as required by subsection (b) of such section, not later than 1 year after the date of enactment of this Act.
Sec. 104 Review, investigation, and report on use of opioids in treatment by Department of Veterans Affairs
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Comptroller general report—
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In general— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Opioid Safety Initiative of the Department of Veterans Affairs and the opioid prescribing practices of health care providers of the Department.
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Elements— The report submitted under paragraph (1) shall include the following:
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Recommendations on such improvements to the Opioid Safety Initiative of the Department as the Comptroller General considers appropriate.
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Information with respect to—
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deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider of the Department;
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overall prescription rates and prescriptions indications of opioids to treat non-cancer, non-palliative, and non-hospice care patients;
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the prescription rates and prescriptions indications of benzodiazepines and opioids concomitantly by health care providers of the Department;
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the practice by health care providers of the Department of prescribing opioids to treat patients without any pain, including to treat patients with mental health disorders other than opioid use disorder; and
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the effectiveness of opioid therapy for patients receiving such therapy, including the effectiveness of long-term opioid therapy.
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An evaluation of processes of the Department in place to oversee opioid use among veterans, including procedures to identify and remedy potential over-prescribing of opioids by health care providers of the Department.
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An assessment of the implementation by the Secretary of the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.
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Quarterly progress report on implementation of comptroller general recommendations— Not later than two years after the date of the enactment of this Act, and not later than 30 days after the end of each quarter thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a progress report detailing the actions by the Secretary during the period covered by the report to address any outstanding findings and recommendations by the Comptroller General of the United States under subsection (a) with respect to the Veterans Health Administration.
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Annual review of prescription rates— Not later than one year after the date of the enactment of this Act, and not less frequently than annually for the following five years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report, with respect to each medical facility of the Department of Veterans Affairs, to collect and review information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients that contains, for the one-year period preceding the submission of the report, the following:
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The number of patients and the percentage of the patient population of the Department who were prescribed benzodiazepines and opioids concurrently by a health care provider of the Department.
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The number of patients and the percentage of the patient population of the Department without any pain who were prescribed opioids by a health care provider of the Department, including those who were prescribed benzodiazepines and opioids concurrently.
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The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the Department on an inpatient-basis and who also received prescription opioids by mail from the Department while being treated on an inpatient-basis.
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The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the Department and a health care provider that is not health care provider of the Department.
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With respect to each medical facility of the Department, information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients, including information on—
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the prescription rate at which each health care provider at the facility prescribed benzodiazepines and opioids concurrently to such patients and the aggregate such prescription rate for all health care providers at the facility;
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the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which benzodiazepines or opioids are not approved treatment and the aggregate such prescription rate for all health care providers at the facility;
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the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate of such prescription rate for all health care providers at the facility; and
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the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider that is not a health care provider of the Department and the aggregate of such prescription rates for all health care providers at the facility.
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With respect to each medical facility of the Department, the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing such medication to a veteran.
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Investigation of prescription rates— If the Secretary determines that a prescription rate with respect to a health care provider or medical facility of the Department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care, the Secretary shall—
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immediately notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives of such determination, including information relating to such determination, prescription rate, and health care provider or medical facility, as the case may be; and
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through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the health care provider or medical facility, as the case may be.
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Prescription rate defined— In this section, the term prescription rate means, with respect to a health care provider or medical facility of the Department, each of the following:
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The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total number of pharmacy users of that health care provider or medical facility.
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The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids.
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Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.
Sec. 105 Mandatory disclosure of certain veteran information to State controlled substance monitoring programs
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Section 5701(l) of title 38, United States Code, is amended by striking “may” and inserting “shall”.
Sec. 201 Community meetings on improving care furnished by Department of Veterans Affairs
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Community meetings—
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Medical centers— Not later than 90 days after the date of the enactment of this Act, and not less frequently than once every 90 days thereafter, the Secretary shall ensure that each medical facility of the Department of Veterans Affairs hosts a community meeting open to the public on improving health care furnished by the Secretary.
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Community based outpatient clinics— Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter, the Secretary shall ensure that each community based outpatient clinic of the Department hosts a community meeting open to the public on improving health care furnished by the Secretary.
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Attendance by Director of veterans integrated service network or designee—
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In general— Each community meeting hosted by a medical facility or community based outpatient clinic under subsection (a) shall be attended by the Director of the Veterans Integrated Service Network in which the medical facility or community based outpatient clinic, as the case may be, is located. Subject to paragraph (2), the Director may delegate such attendance only to an employee who works in the Office of the Director.
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Attendance by director— Each Director of a Veterans Integrated Service Network shall personally attend not less than one community meeting under subsection (a) hosted by each medical facility located in the Veterans Integrated Service Network each year.
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Notice— The Secretary shall notify the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and each Member of Congress (as defined in section 104) who represents the area in which the medical facility is located of a community meeting under subsection (a) by not later than 10 days before such community meeting occurs.
Sec. 202 Improvement of awareness of patient advocacy program and patient bill of rights of Department of Veterans Affairs
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Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, in as many prominent locations as the Secretary determines appropriate to be seen by the largest percentage of patients and family members of patients at each medical facility of the Department of Veterans Affairs—
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display the purposes of the Patient Advocacy Program of the Department and the contact information for the patient advocate at such medical facility; and
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display the rights and responsibilities of—
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patients and family members and patients at such medical facility; and
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with respect to community living centers and other residential facilities of the Department, residents and family members of residents at such medical facility.
Sec. 203 Comptroller general report on patient advocacy program of Department of Veterans Affairs
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In general— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Patient Advocacy Program of the Department of Veterans Affairs (in this section referred to as the “Program”).
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Elements— The report required by subsection (a) shall include the following:
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A description of the Program, including—
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the purpose of the Program;
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the activities carried out under the Program; and
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the sufficiency of the Program in achieving the purpose of the Program.
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An assessment of the sufficiency of staffing of employees of the Department responsible for carrying out the Program.
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An assessment of the sufficiency of the training of such employees.
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An assessment of—
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the awareness of the Program among veterans and family members of veterans; and
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the use of the Program by veterans and family members of veterans.
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Such recommendations and proposals for improving or modifying the Program as the Comptroller General considers appropriate.
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Such other information with respect to the Program as the Comptroller General considers appropriate.
Sec. 301 Expansion of research and education on and delivery of complementary and integrative health to veterans
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Establishment— There is established a commission to be known as the “Creating Options for Veterans’ Expedited Recovery” or the “COVER Commission” (in this Act referred to as the “Commission”). The Commission shall examine the evidence-based therapy treatment model used by the Secretary of Veterans Affairs for treating mental health conditions of veterans and the potential benefits of incorporating complementary alternative treatments available in non-Department facilities (as defined in section 1701 of title 38, United States Code).
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Duties— The Commission shall perform the following duties:
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Examine the efficacy of the evidence-based therapy model used by the Secretary for treating mental health illnesses of veterans and identify areas to improve wellness-based outcomes.
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Conduct a patient-centered survey within each of the Veterans Integrated Service Networks to examine—
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the experience of veterans with the Department of Veterans Affairs when seeking medical assistance for mental health issues through the health care system of the Department;
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the experience of veterans with non-Department facilities and health professionals for treating mental health issues;
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the preference of veterans regarding available treatment for mental health issues and which methods the veterans believe to be most effective;
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the experience, if any, of veterans with respect to the complementary alternative treatment therapies described in paragraph (3);
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the prevalence of prescribing prescription medication among veterans seeking treatment through the health care system of the Department as remedies for addressing mental health issues; and
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the outreach efforts of the Secretary regarding the availability of benefits and treatments for veterans for addressing mental health issues, including by identifying ways to reduce barriers to gaps in such benefits and treatments.
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Examine available research on complementary alternative treatment therapies for mental health issues and identify what benefits could be made with the inclusion of such treatments for veterans, including with respect to—
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music therapy;
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equine therapy;
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training and caring for service dogs;
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yoga therapy;
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acupuncture therapy;
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meditation therapy;
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outdoor sports therapy;
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hyperbaric oxygen therapy;
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accelerated resolution therapy;
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art therapy;
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magnetic resonance therapy; and
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other therapies the Commission determines appropriate.
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Study the sufficiency of the resources of the Department to ensure the delivery of quality health care for mental health issues among veterans seeking treatment within the Department.
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Study the current treatments and resources available within the Department and assess—
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the effectiveness of such treatments and resources in decreasing the number of suicides per day by veterans;
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the number of veterans who have been diagnosed with mental health issues;
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the percentage of veterans using the resources of the Department who have been diagnosed with mental health issues;
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the percentage of veterans who have completed counseling sessions offered by the Department; and
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the efforts of the Department to expand complementary alternative treatments viable to the recovery of veterans with mental health issues as determined by the Secretary to improve the effectiveness of treatments offered with the Department.
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Membership—
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In general— The Commission shall be composed of 10 members, appointed as follows:
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Two members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.
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Two members appointed by the Minority Leader of the House of Representatives, at least one of whom shall be a veteran.
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Two members appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran.
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Two members appointed by the Minority Leader of the Senate, at least one of whom shall be a veteran.
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Two members appointed by the President, at least one of whom shall be a veteran.
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Qualifications— Members of the Commission shall be—
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individuals who are of recognized standing and distinction within the medical community with a background in treating mental health;
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individuals with experience working with the military and veteran population; and
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individuals who do not have a financial interest in any of the complementary alternative treatments reviewed by the Commission.
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Chairman— The President shall designate a member of the Commission to be the Chairman.
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Period of appointment— Members of the Commission shall be appointed for the life of the Commission.
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Vacancy— A vacancy in the Commission shall be filled in the manner in which the original appointment was made.
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Appointment deadline— The appointment of members of the Commission in this section shall be made not later than 90 days after the date of the enactment of this Act.
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Powers of commission—
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Meetings—
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Initial meeting— The Commission shall hold its first meeting not later than 30 days after a majority of members are appointed to the Commission.
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Meeting— The Commission shall regularly meet at the call of the Chairman. Such meetings may be carried out through the use of telephonic or other appropriate telecommunication technology if the Commission determines that such technology will allow the members to communicate simultaneously.
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Hearings— The Commission may hold such hearings, sit and act at such times and places, take such testimony, and receive evidence as the Commission considers advisable to carry out the responsibilities of the Commission.
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Information from federal agencies— The Commission may secure directly from any department or agency of the Federal Government such information as the Commission considers necessary to carry out the duties of the Commission.
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Information from nongovernmental organizations— In carrying out its duties, the Commission may seek guidance through consultation with foundations, veteran service organizations, nonprofit groups, faith-based organizations, private and public institutions of higher education, and other organizations as the Commission determines appropriate.
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Commission records— The Commission shall keep an accurate and complete record of the actions and meeting of the Commission. Such record shall be made available for public inspection and the Comptroller General of the United States may audit and examine such record.
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Personnel records— The Commission shall keep an accurate and complete record of the actions and meetings of the Commission. Such record shall be made available for public inspection and the Comptroller General of the United States may audit and examine such records.
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Compensation of members; travel expenses— Each member shall serve without pay but shall receive travel expenses to perform the duties of the Commission, including per diem in lieu of substances, at rates authorized under subchapter I of chapter 57 of title 5, United States Code.
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Staff— The Chairman, in accordance with rules agreed upon the Commission, may appoint fix the compensation of a staff director and such other personnel as may be necessary to enable the Commission to carry out its functions, without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, without regard to the provision of chapter 51 and subchapter III of chapter 53 of such title relating to classification and General Schedule pay rates, except that no rate of pay fixed under this paragraph may exceed the equivalent of that payable for a position at a level IV of the Executive Schedule under section 5316 of title 5, United States Code.
removed
Personnel as federal employees—
removed
In general— The executive director and any personnel of the Commission are employees under section 2105 of title 5, United States Code, for purpose of chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such title.
removed
Members of the commission— Subparagraph (A) shall not be construed to apply to members of the Commission.
removed
Contracting— The Commission may, to such extent and in such amounts as are provided in appropriations Acts, enter into contracts to enable the Commission to discharge the duties of the Commission under this Act.
removed
Expert and consultant service— The Commission may procure the services of experts and consultants in accordance with section 3109 or title 5, United States Code, at rates not to exceed the daily rate paid to a person occupying a position at level IV of the Executive Schedule under section 3109 of title 5, United States Code.
removed
Postal service— The Commission may use the United States mails in the same manner and under the same conditions as departments and agencies of the United States.
removed
Physical facilities and equipment— Upon the request of the Commission, the Administrator of General Services shall provide to the Commission, on a reimbursable basis, the administrative support services necessary for the Commission to carry out its responsibilities under this Act. These administrative services may include human resource management, budget, leasing accounting, and payroll services.
removed
Report—
removed
Interim reports—
removed
In general— Not later than 60 days after the date on which the Commission first meets, and each 30-day period thereafter ending on the date on which the Commission submits the final report under paragraph (2), the Commission shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate and the President a report detailing the level of cooperation the Secretary of Veterans Affairs (and the heads of other departments or agencies of the Federal Government) has provided to the Commission.
removed
Other reports— In carrying out its duties, at times that the Commission determines appropriate, the Commission shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate and any other appropriate entities an interim report with respect to the findings identified by the Commission.
removed
Final report— Not later than 18 months after the first meeting of the Commission, the Commission shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate, the President, and the Secretary of Veterans Affairs a final report on the findings of the Commission. Such report shall include the following:
removed
Recommendations to implement in a feasible, timely, and cost efficient manner the solutions and remedies identified within the findings of the Commission pursuant to subsection (b).
removed
An analysis of the evidence-based therapy model used by the Secretary of Veterans Affairs for treating veterans with mental health care issues, and an examination of the prevalence and efficacy of prescription drugs as a means for treatment.
removed
The findings of the patient-centered survey conducted within each of the Veterans Integrated Service Networks pursuant to subsection (b)(2).
removed
An examination of complementary alternative treatments described in subsection (b)(3) and the potential benefits of incorporating such treatments in the therapy models used by the Secretary for treating veterans with mental health issues.
removed
Plan— Not later than 90 days after the date on which the Commission submits the final report under paragraph (2), the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the House of Representatives and the Senate a report on the following:
removed
An action plan for implementing the recommendations established by the Commission on such solutions and remedies for improving wellness-based outcomes for veterans with mental health care issues.
removed
A feasible timeframe on when the complementary alternative treatments described in subsection (b)(3) can be implemented Department-wide.
removed
With respect to each recommendation established by the Commission, including any complementary alternative treatment, that the Secretary determines is not appropriate or feasible to implement, a justification for such determination and an alternative solution to improve the efficacy of the therapy models used by the Secretary for treating veterans with mental health issues.
removed
Termination of commission— The Commission shall terminate 30 days after the Commission submits the final report under subsection (e)(2).
Sec. 302 Pilot program on integration of complementary alternative medicines and related issues for veterans and family members of veterans
removed
removed
Pilot program—
removed
In general— Not later than 180 days after the date on which the Secretary of Veterans Affairs receives the final report under section 301(e), the Secretary shall commence a pilot program to assess the feasibility and advisability of using wellness-based programs (as defined by the Secretary) to complement the provision of pain management and related health care services, including mental health care services, to veterans.
removed
Matters addressed— In carrying out the pilot program, the Secretary shall assess the following:
removed
Means of improving coordination between Federal, State, local, and community providers of health care in the provision of pain management and related health care services to veterans.
removed
Means of enhancing outreach, and coordination of outreach, by and among providers of health care referred to in subparagraph (A) on the pain management and related health care services available to veterans.
removed
Means of using wellness-based programs of providers of health care referred to in subparagraph (A) as complements to the provision by the Department of pain management and related health care services to veterans.
removed
Whether wellness-based programs described in subparagraph (C)—
removed
are effective in enhancing the quality of life and well-being of veterans;
removed
are effective in increasing the adherence of veterans to the primary pain management and related health care services provided such veterans by the Department;
removed
have an effect on the sense of well-being of veterans who receive primary pain management and related health care services from the Department; and
removed
are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle.
removed
Duration— The Secretary shall carry out the pilot program under subsection (a)(1) for a period of three years.
removed
Locations—
removed
Facilities— The Secretary shall carry out the pilot program under subsection (a)(1) at facilities of the Department providing pain management and related health care services, including mental health care services, to veterans. In selecting such facilities to carry out the pilot program, the Secretary shall select not fewer than 15 medical centers of the Department, of which not fewer than two shall be polytrauma rehabilitation centers of the Department.
removed
Medical centers with prescription rates of opioids that conflict with care standards— In selecting the medical centers under paragraph (1), the Secretary shall give priority to medical centers of the Department at which there is a prescription rate of opioids that conflicts with or is otherwise inconsistent with the standards of appropriate and safe care.
removed
Provision of services— Under the pilot program under subsection (a)(1), the Secretary shall provide covered services to covered veterans by integrating complementary and alternative medicines and integrative health services with other services provided by the Department at the medical centers selected under subsection (c).
removed
Covered veterans— For purposes of the pilot program under subsection (a)(1), a covered veteran is any veteran who—
removed
has a mental health condition diagnosed by a clinician of the Department;
removed
experiences chronic pain;
removed
has a chronic condition being treated by a clinician of the Department; or
removed
is not described in paragraph (1), (2), or (3) and requests to participate in the pilot program or is referred by a clinician of the Department who is treating the veteran.
removed
Covered services—
removed
In general— For purposes of the pilot program, covered services are services consisting of complementary and integrative health services as selected by the Secretary.
removed
Administration of services— Covered services shall be administered under the pilot program as follows:
removed
Covered services shall be administered by professionals or other instructors with appropriate training and expertise in complementary and integrative health services who are employees of the Department or with whom the Department enters into an agreement to provide such services.
removed
Covered services shall be included as part of the Patient Aligned Care Teams initiative of the Office of Patient Care Services, Primary Care Program Office, in coordination with the Office of Patient Centered Care and Cultural Transformation.
removed
Covered services shall be made available to—
removed
covered veterans who have received conventional treatments from the Department for the conditions for which the covered veteran seeks complementary and integrative health services under the pilot program; and
removed
covered veterans who have not received conventional treatments from the Department for such conditions.
removed
Reports—
removed
In general— Not later than 30 months after the date on which the Secretary commences the pilot program under subsection (a)(1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the pilot program.
removed
Elements— The report under paragraph (1) shall include the following:
removed
The findings and conclusions of the Secretary with respect to the pilot program under subsection (a)(1), including with respect to—
removed
the use and efficacy of the complementary and integrative health services established under the pilot program;
removed
the outreach conducted by the Secretary to inform veterans and community organizations about the pilot program; and
removed
an assessment of the benefit of the pilot program to covered veterans in mental health diagnoses, pain management, and treatment of chronic illness.
removed
Identification of any unresolved barriers that impede the ability of the Secretary to incorporate complementary and integrative health services with other health care services provided by the Department.
removed
Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate.
removed
Complementary and integrative health defined— In this section, the term complementary and integrative health shall have the meaning given that term by the National Institutes of Health.
Sec. 401 Additional requirements for hiring of health care providers by Department of Veterans Affairs
removed
removed
As part of the hiring process for each health care provider considered for a position at the Department of Veterans Affairs after the date of the enactment of the Act, the Secretary of Veterans Affairs shall require from the medical board of each State in which the health care provider has a medical license—
removed
information on any violation of the requirements of the medical license of the health care provider during the 20-year period preceding the consideration of the health care provider by the Department; and
removed
information on whether the health care provider has entered into any settlement agreement for the disciplinary charge relating to the practice of medicine by the health care provider.
Sec. 402 Provision of information on health care providers of Department of Veterans Affairs to State Medical Boards
removed
removed
Notwithstanding section 552a of title 5, United States Code, with respect to each health care provider of the Department of Veterans Affairs who has violated a requirement of the medical license of the health care provider, the Secretary of Veterans Affairs shall provide to the medical board of each State in which the health care provider is licensed detailed information with respect to such violation, regardless of whether such board has formally requested such information.
Sec. 403 Report on compliance by Department of Veterans Affairs with reviews of health care providers leaving the Department or transferring to other facilities
removed
removed
Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the compliance by the Department of Veterans Affairs with the policy of the Department—
removed
to conduct a review of each health care provider of the Department who transfers to another medical facility of the Department, retires, or is terminated to determine whether there are any concerns, complaints, or allegations of violations relating to the medical practice of the health care provider; and
removed
to take appropriate action with respect to any such concern, complaint, or allegation.
Sec. 501 Audit of Veterans Health Administration programs of Department of Veterans Affairs
removed
removed
Audit— The Secretary of Veterans Affairs shall seek to enter into a contract with a nongovernmental entity under which the entity shall conduct a audits of the programs of the Veterans Health Administration of the Department of Veterans Affairs to identify ways to improve the furnishing of benefits and health care administered by the Veterans Health Administration to veterans and families of veterans.
removed
Audit requirements— In carrying out each audit under subsection (a), the entity shall perform the following:
removed
Five-year risk assessments to identify the functions, staff organizations, and staff offices of the Veterans Health Administration that would lead towards the greatest improvement in furnishing of benefits and health care to veterans and families of veterans.
removed
Development of plans that are informed by the risk assessment under paragraph (1) to conduct audits of the functions, staff organizations, and staff offices identified under paragraph (1).
removed
Conduct audits in accordance with the plans developed pursuant to paragraph (2).
removed
Reports— Not later than 90 days after the date on which each audit is completed under subsection (a), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report that includes—
removed
a summary of the audit;
removed
the findings of the entity that conducted the audit with respect to the audit; and
removed
such recommendations as the Secretary determines appropriate for legislative or administrative action to improve the furnishing of benefits and health care to veterans and families of veterans.
Sec. 2 Improvement of opioid safety measures by Department of Veterans Affairs
added
added
Expansion of opioid safety initiative—
added
Inclusion of all medical facilities— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall expand the Opioid Safety Initiative of the Department of Veterans Affairs to include all medical facilities of the Department.
added
Guidance— The Secretary shall establish guidance that each health care provider of the Department of Veterans Affairs, before initiating opioid therapy to treat a patient as part of the comprehensive assessment conducted by the health care provider, use the Opioid Therapy Risk Report tool of the Department of Veterans Affairs (or any subsequent tool), which shall include information from the prescription drug monitoring program of each participating State as applicable, that includes the most recent information to date relating to the patient that accessed such program to assess the risk for adverse outcomes of opioid therapy for the patient, including the concurrent use of controlled substances such as benzodiazepines, as part of the comprehensive assessment conducted by the health care provider.
added
Enhanced standards— The Secretary shall establish enhanced standards with respect to the use of routine and random urine drug tests for all patients before and during opioid therapy to help prevent substance abuse, dependence, and diversion, including—
added
that such tests occur not less frequently than once each year; and
added
that health care providers appropriately order, interpret and respond to the results from such tests to tailor pain therapy, safeguards, and risk management strategies to each patient.
added
Pain management education and training—
added
In general— In carrying out the Opioid Safety Initiative of the Department, the Secretary shall require all employees of the Department responsible for prescribing opioids to receive education and training described in paragraph (2).
added
Education and training— Education and training described in this paragraph is education and training on pain management and safe opioid prescribing practices for purposes of safely and effectively managing patients with chronic pain, including education and training on the following:
added
The implementation of and full compliance with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline.
added
The use of evidence-based pain management therapies, including cognitive-behavioral therapy, non-opioid alternatives, and non-drug methods and procedures to managing pain and related health conditions including medical devices approved or cleared by the Food and Drug Administration for the treatment of patients with chronic pain and complementary alternative medicines.
added
Screening and identification of patients with substance use disorder, including drug-seeking behavior, before prescribing opioids, assessment of risk potential for patients developing an addiction, and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected.
added
Communication with patients on the potential harm associated with the use of opioids and other controlled substances, including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances.
added
Such other education and training as the Secretary considers appropriate to ensure that veterans receive safe and high-quality pain management care from the Department.
added
Use of existing program— In providing education and training described in paragraph (2), the Secretary shall use the Interdisciplinary Chronic Pain Management Training Team Program of the Department (or success program).
added
Pain management teams—
added
In general— In carrying out the Opioid Safety Initiative of the Department, the director of each medical facility of the Department shall identify and designate a pain management team of health care professionals, which may include board certified pain medicine specialists, responsible for coordinating and overseeing pain management therapy at such facility for patients experiencing acute and chronic pain that is non-cancer related.
added
Establishment of protocols—
added
In general— In consultation with the Directors of each Veterans Integrated Service Network, the Secretary shall establish standard protocols for the designation of pain management teams at each medical facility within the Department.
added
Consultation on prescription of opioids— Each protocol established under subparagraph (A) shall ensure that any health care provider without expertise in prescribing analgesics or who has not completed the education and training under subsection (b), including a mental health care provider, does not prescribe opioids to a patient unless that health care provider—
added
consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and
added
refers the patient to the pain management team for any subsequent prescriptions and related therapy.
added
Report—
added
In general— Not later than 1 year after the date of enactment of this Act, the director of each medical facility of the Department shall submit to the Under Secretary for Health and the director of the Veterans Integrated Service Network in which the medical facility is located a report identifying the health care professionals that have been designated as members of the pain management team at the medical facility pursuant to paragraph (1).
added
Elements— Each report submitted under subparagraph (A) with respect to a medical facility of the Department shall include—
added
a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection (b);
added
a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is non-cancer related; and
added
a certification as to whether the medical facility—
added
fully complies with the stepped-care model of pain management and other pain management policies contained in Directive 2009–053 of the Veterans Health Administration, or successor directive; or
added
does not fully comply with such stepped-care model of pain management and other pain management policies but is carrying out a corrective plan of action to ensure such full compliance.
added
Tracking and monitoring of opioid use—
added
Prescription drug monitoring programs of states— In carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool of the Department, the Secretary shall—
added
ensure access by health care providers of the Department to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the Department through the prescription drug monitoring program of each State with such a program, including by seeking to enter into memoranda of understanding with States to allow shared access of such information between States and the Department;
added
include such information in the Opioid Therapy Risk Report; and
added
require health care providers of the Department to submit to the prescription drug monitoring program of each State information on prescriptions of controlled substances received by veterans in that State under the laws administered by the Secretary.
added
Report on tracking of data on opioid use— Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the feasibility and advisability of improving the Opioid Therapy Risk Report tool of the Department to allow for more advanced real-time tracking of and access to data on—
added
the key clinical indicators with respect to the totality of opioid use by veterans;
added
concurrent prescribing by health care providers of the Department of opioids in different health care settings, including data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder; and
added
mail-order prescriptions of opioid prescribed to veterans under the laws administered by the Secretary.
added
Availability of opioid receptor antagonists—
added
Increased availability and use—
added
In general— The Secretary shall maximize the availability of opioid receptor antagonists approved by the Food and Drug Administration, including naloxone, to veterans.
added
Availability, training, and distributing— In carrying out subparagraph (A), not later than 90 days after the date of the enactment of this Act, the Secretary shall—
added
equip each pharmacy of the Department with opioid receptor antagonists approved by the Food and Drug Administration to be dispensed to outpatients as needed; and
added
expand the Overdose Education and Naloxone Distribution program of the Department to ensure that all veterans in receipt of health care under laws administered by the Secretary who are at risk of opioid overdose may access such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists.
added
Veterans who are at risk— For purposes of subparagraph (B), veterans who are at risk of opioid overdose include—
added
veterans receiving long-term opioid therapy;
added
veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and
added
veterans who are at risk as determined by a health care provider who is treating the veteran.
added
Report— Not later than 120 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on carrying out paragraph (1), including an assessment of any remaining steps to be carried out by the Secretary to carry out such paragraph.
added
Inclusion of certain information and capabilities in opioid therapy risk report tool of the Department—
added
Information— The Secretary shall include in the Opioid Therapy Risk Report tool of the Department—
added
information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and
added
information on the results of the most recent urine drug test for each veteran.
added
Capabilities— The Secretary shall include in the Opioid Therapy Risk Report tool the ability of the health care providers of the Department to determine whether a health care provider of the Department prescribed opioids to a veteran without checking the information in the tool with respect to the veteran.
added
Notifications of risk in computerized health record— The Secretary shall modify the computerized patient record system of the Department to ensure that any health care provider that accesses the record of a veteran, regardless of the reason the veteran seeks care from the health care provider, will be immediately notified whether the veteran—
added
is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose;
added
has a history of opioid abuse; or
added
is at risk of becoming an opioid abuser as determined by a health care provider who is treating the veteran.
added
Definitions— In this section:
added
The term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
added
The term State means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Sec. 3 Strengthening of joint working group on pain management of the Department of Veterans Affairs and the Department of Defense
added
added
In general— Not later than 90 days after the date of enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the Pain Management Working Group of the Health Executive Committee of the Department of Veterans Affairs–Department of Defense Joint Executive Committee (Pain Management Working Group) established under section 320 of title 38, United States Code, includes a focus on the following:
added
The opioid prescribing practices of health care providers of each Department.
added
The ability of each Department to manage acute and chronic pain among individuals receiving health care from the Department, including training health care providers with respect to pain management.
added
The use by each Department of complementary and integrative health and complementary alternative medicines in treating such individuals.
added
The concurrent use by health care providers of each Department of opioids and prescription drugs to treat mental health disorders, including benzodiazepines.
added
The practice by health care providers of each Department of prescribing opioids to treat mental health disorders.
added
The coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from the Department of Defense to receiving health care from the Department of Veterans Affairs.
added
The ability of each Department to identify and treat substance use disorders among individuals receiving health care from that Department.
added
Coordination and consultation— The Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the working group described in subsection (a)—
added
coordinates the activities of the working group with other relevant working groups established under section 320 of title 38, United States Code;
added
consults with other relevant Federal agencies with respect to the activities of the working group; and
added
consults with the Department of Veterans Affairs and the Department of Defense with respect to, reviews, and comments on the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, or any successor guideline, before any update to the guideline is released.
added
Clinical practice guidelines—
added
In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall issue an update to the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.
added
Matters included— In conducting the update under subsection (a), the Pain Management Working Group, in coordination with the Clinical Practice Guideline VA/DOD Management of Opioid Therapy for Chronic Pain Working Group, shall examine whether the Clinical Practical Guideline should include the following:
added
Enhanced guidance with respect to—
added
the coadministration of an opioid and other drugs, including benzodiazepines, that may result in life-limiting drug interactions;
added
the treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide; and
added
the use of opioid therapy to treat mental health disorders other than opioid use disorder.
added
Enhanced guidance with respect to the treatment of patients with behaviors or comorbidities, such as post-traumatic stress disorder or other psychiatric disorders, or a history of substance abuse or addiction, that requires a consultation or comanagement of opioid therapy with one or more specialists in pain management, mental health, or addictions.
added
Enhanced guidance with respect to health care providers—
added
conducting an effective assessment for patients beginning or continuing opioid therapy, including understanding and setting realistic goals with respect to achieving and maintaining an expected level of pain relief, improved function, or a clinically appropriate combination of both; and
added
effectively assessing whether opioid therapy is achieving or maintaining the established treatment goals of the patient or whether the patient and health care provider should discuss adjusting, augmenting, or discontinuing the opioid therapy.
added
Guidelines to govern the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to taper opioid therapy when adjusting or discontinuing the use of opioid therapy.
added
Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition between inpatient and outpatient health care settings, which may include the use of care transition plans.
added
Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition from receiving care during active duty to post-military health care networks.
added
Guidelines with respect to providing options, before initiating opioid therapy, for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence.
added
Guidelines with respect to the provision of evidence-based non-opioid treatments within the Department of Veterans Affairs and the Department of Defense, including medical devices and other therapies approved or cleared by the Food and Drug Administration for the treatment of chronic pain as an alternative to or to augment opioid therapy.
Sec. 4 Review, investigation, and report on use of opioids in treatment by Department of Veterans Affairs
added
added
Comptroller general report—
added
In general— Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Opioid Safety Initiative of the Department of Veterans Affairs and the opioid prescribing practices of health care providers of the Department.
added
Elements— The report submitted under paragraph (1) shall include the following:
added
Recommendations on such improvements to the Opioid Safety Initiative of the Department as the Comptroller General considers appropriate.
added
Information with respect to—
added
deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider of the Department;
added
overall prescription rates and prescriptions indications of opioids to treat non-cancer, non-palliative, and non-hospice care patients;
added
the prescription rates and prescriptions indications of benzodiazepines and opioids concomitantly by health care providers of the Department;
added
the practice by health care providers of the Department of prescribing opioids to treat patients without any pain, including to treat patients with mental health disorders other than opioid use disorder; and
added
the effectiveness of opioid therapy for patients receiving such therapy, including the effectiveness of long-term opioid therapy.
added
An evaluation of processes of the Department in place to oversee opioid use among veterans, including procedures to identify and remedy potential over-prescribing of opioids by health care providers of the Department.
added
An assessment of the implementation by the Secretary of the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.
added
Quarterly progress report on implementation of comptroller general recommendations— Not later than 2 years after the date of the enactment of this Act, and not later than 30 days after the end of each quarter thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a progress report detailing the actions by the Secretary during the period covered by the report to address any outstanding findings and recommendations by the Comptroller General of the United States under subsection (a) with respect to the Veterans Health Administration.
added
Annual review of prescription rates— Not later than 1 year after the date of the enactment of this Act, and not less frequently than annually for the following 5 years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report, with respect to each medical facility of the Department of Veterans Affairs, to collect and review information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients that contains, for the 1-year period preceding the submission of the report, the following:
added
The number of patients and the percentage of the patient population of the Department who were prescribed benzodiazepines and opioids concurrently by a health care provider of the Department.
added
The number of patients and the percentage of the patient population of the Department without any pain who were prescribed opioids by a health care provider of the Department, including those who were prescribed benzodiazepines and opioids concurrently.
added
The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the Department on an inpatient-basis and who also received prescription opioids by mail from the Department while being treated on an inpatient-basis.
added
The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the Department and a health care provider that is not health care provider of the Department.
added
With respect to each medical facility of the Department, information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients, including information on—
added
the prescription rate at which each health care provider at the facility prescribed benzodiazepines and opioids concurrently to such patients and the aggregate such prescription rate for all health care providers at the facility;
added
the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which benzodiazepines or opioids are not approved treatment and the aggregate such prescription rate for all health care providers at the facility;
added
the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate of such prescription rate for all health care providers at the facility; and
added
the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider that is not a health care provider of the Department and the aggregate of such prescription rates for all health care providers at the facility.
added
With respect to each medical facility of the Department, the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing such medication to a veteran.
added
Investigation of prescription rates— If the Secretary determines that a prescription rate with respect to a health care provider or medical facility of the Department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care, the Secretary shall—
added
immediately notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives of such determination, including information relating to such determination, prescription rate, and health care provider or medical facility, as the case may be; and
added
through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the health care provider or medical facility, as the case may be.
added
Prescription rate defined— In this section, the term prescription rate means, with respect to a health care provider or medical facility of the Department, each of the following:
added
The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total number of pharmacy users of that health care provider or medical facility.
added
The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids.
added
Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.
Sec. 5 Mandatory disclosure of certain veteran information to State controlled substance monitoring programs
addedadded Section 5701(l) of title 38, United States Code, is amended by striking “may” and inserting “shall”.
Sec. 6 Modification to limitation on awards and bonuses
addedadded Section 705 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 703 note) is amended to read as follows:
added “705. Limitation on awards and bonuses paid to employees of Department of Veterans Affairs
added “The Secretary of Veterans Affairs shall ensure that the aggregate amount of awards and bonuses paid by the Secretary in a fiscal year under chapter 45 or 53 of title 5, United States Code, or any other awards or bonuses authorized under such title or title 38, United States Code, does not exceed the following amounts:
added “(1) With respect to each of fiscal years 2017 through 2021, $230,000,000.
added “(2) With respect to each of fiscal years 2022 through 2024, $360,000,000.”