H.R. 4063 — what changed

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.

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).

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:

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.

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.

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.

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.

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).

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.

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.

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—

consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and

refers the patient to the pain management team for any subsequent prescriptions and related therapy.

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).

Elements— Each report submitted under subparagraph (A) with respect to a medical facility of the Department shall include—

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—

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;

include such information in the Opioid Therapy Risk Report; and

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.

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—

the key clinical indicators with respect to the totality of opioid use by veterans;

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

mail-order prescriptions of opioid prescribed to veterans under the laws administered by the Secretary.

In general— The Secretary shall maximize the availability of opioid receptor antagonists approved by the Food and Drug Administration, including naloxone, to veterans.

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—

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

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.

Veterans who are at risk— For purposes of subparagraph (B), veterans who are at risk of opioid overdose include—

veterans receiving long-term opioid therapy;

veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and

veterans who are at risk as determined by a health care provider who is treating the veteran.

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.

Information— The Secretary shall include in the Opioid Therapy Risk Report tool of the Department—

information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and

information on the results of the most recent urine drug test for each veteran.

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.

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—

is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose;

has a history of opioid abuse; or

is at risk of becoming an opioid abuser as determined by a health care provider who is treating the veteran.

Definitions— In this section:

The term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).

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.

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).

Duties— The Commission shall perform the following duties:

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.

Conduct a patient-centered survey within each of the Veterans Integrated Service Networks to examine—

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;

the experience of veterans with non-Department facilities and health professionals for treating mental health issues;

the preference of veterans regarding available treatment for mental health issues and which methods the veterans believe to be most effective;

the experience, if any, of veterans with respect to the complementary alternative treatment therapies described in paragraph (3);

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

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.

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—

music therapy;

equine therapy;

training and caring for service dogs;

yoga therapy;

acupuncture therapy;

meditation therapy;

outdoor sports therapy;

hyperbaric oxygen therapy;

accelerated resolution therapy;

art therapy;

magnetic resonance therapy; and

other therapies the Commission determines appropriate.

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.

Study the current treatments and resources available within the Department and assess—

the effectiveness of such treatments and resources in decreasing the number of suicides per day by veterans;

the number of veterans who have been diagnosed with mental health issues;

the percentage of veterans using the resources of the Department who have been diagnosed with mental health issues;

the percentage of veterans who have completed counseling sessions offered by the Department; and

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.

In general— The Commission shall be composed of 10 members, appointed as follows:

Two members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.

Two members appointed by the Minority Leader of the House of Representatives, at least one of whom shall be a veteran.

Two members appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran.

Two members appointed by the Minority Leader of the Senate, at least one of whom shall be a veteran.

Two members appointed by the President, at least one of whom shall be a veteran.

Qualifications— Members of the Commission shall be—

individuals who are of recognized standing and distinction within the medical community with a background in treating mental health;

individuals with experience working with the military and veteran population; and

individuals who do not have a financial interest in any of the complementary alternative treatments reviewed by the Commission.

Chairman— The President shall designate a member of the Commission to be the Chairman.

Period of appointment— Members of the Commission shall be appointed for the life of the Commission.

Vacancy— A vacancy in the Commission shall be filled in the manner in which the original appointment was made.

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.

Initial meeting— The Commission shall hold its first meeting not later than 30 days after a majority of members are appointed to the Commission.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Members of the commission— Subparagraph (A) shall not be construed to apply to members of the Commission.

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.

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.

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.

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.

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.

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.

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:

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).

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.

The findings of the patient-centered survey conducted within each of the Veterans Integrated Service Networks pursuant to subsection (b)(2).

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.

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:

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.

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.

Termination of commission— The Commission shall terminate 30 days after the Commission submits the final report under subsection (e)(2).

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

to take appropriate action with respect to any such concern, complaint, or allegation.