[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2645 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2645
To provide access to medication-assisted therapy, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 23, 2014
Mr. Markey (for himself, Mrs. Feinstein, Mr. Rockefeller, Mr. Brown,
Ms. Hirono, and Mr. Durbin) introduced the following bill; which was
read twice and referred to the Committee on Health, Education, Labor,
and Pensions
_______________________________________________________________________
A BILL
To provide access to medication-assisted therapy, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Recovery Enhancement for Addiction
Treatment Act'' or the ``TREAT Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Overdoses from opioids have increased dramatically in
the United States.
(2) Deaths from drug overdose, largely from prescription
pain relievers, have tripled among men and increased five-fold
among women over the past decade.
(3) Nationwide, drug overdoses now claim more lives than
car accidents.
(4) Opioid addiction is a chronic disease that, untreated,
places a large burden on the healthcare system. Roughly 475,000
emergency room visits each year are attributable to the misuse
and abuse of opioid pain medication.
(5) Effective medication-assisted treatment for opioid
addiction can decrease overdose deaths, be cost-effective,
reduce transmissions of HIV and viral hepatitis, and reduce
other social harms such as criminal activity.
(6) Effective medication-assisted treatment programs for
opioid addiction should include multiple components, including
medications, cognitive and behavioral supports and
interventions, and drug testing.
(7) Effective medication-assisted treatment programs for
opioid addiction may use a team of staff members, in addition
to a prescribing provider, to deliver comprehensive care.
(8) Access to medication-assisted treatments, including
office-based buprenorphine opioid treatment, remains limited in
part due to current practice regulations and an insufficient
number of providers.
(9) More than 10 years of experience in the United States
with office-based buprenorphine opioid treatment has informed
best practices for delivering successful, high quality care.
SEC. 3. EXPANSION OF PATIENT LIMITS UNDER WAIVER.
Section 303(g)(2)(B) of the Controlled Substances Act (21 U.S.C.
823(g)(2)(B)) is amended--
(1) in clause (i), by striking ``physician'' and inserting
``practitioner'';
(2) in clause (iii)--
(A) by striking ``30'' and inserting ``100''; and
(B) by striking ``, unless, not sooner'' and all
that follows through the end and inserting a period;
and
(3) by inserting at the end the following new clause:
``(iv) Not earlier than 1 year after the date on
which a qualifying practitioner obtained an initial
waiver pursuant to clause (iii), the qualifying
practitioner may submit a second notification to the
Secretary of the need and intent of the qualifying
practitioner to treat an unlimited number of patients,
if the qualifying practitioner--
``(I)(aa) satisfies the requirements of
item (aa), (bb), (cc), or (dd) of subparagraph
(G)(ii)(I); and
``(bb) agrees to fully participate in the
Prescription Drug Monitoring Program of the
State in which the qualifying practitioner is
licensed, pursuant to applicable State
guidelines; or
``(II)(aa) satisfies the requirements of
item (ee), (ff), or (gg) of subparagraph
(G)(ii)(I);
``(bb) agrees to fully participate in the
Prescription Drug Monitoring Program of the
State in which the qualifying practitioner is
licensed, pursuant to applicable State
guidelines;
``(cc) practices in a qualified practice
setting; and
``(dd) has completed not less than 24 hours
of training (through classroom situations,
seminars at professional society meetings,
electronic communications, or otherwise) with
respect to the treatment and management of
opiate-dependent patients for substance use
disorders provided by the American Society of
Addiction Medicine, the American Academy of
Addiction Psychiatry, the American Medical
Association, the American Osteopathic
Association, the American Psychiatric
Association, or any other organization that the
Secretary determines is appropriate for
purposes of this subclause.''.
SEC. 4. DEFINITIONS.
Section 303(g)(2)(G) of the Controlled Substances Act (21 U.S.C.
823(g)(2)(G)) is amended--
(1) by striking clause (ii) and inserting the following:
``(ii) The term `qualifying practitioner' means the
following:
``(I) A physician who is licensed under
State law and who meets 1 or more of the
following conditions:
``(aa) The physician holds a board
certification in addiction psychiatry
from the American Board of Medical
Specialties.
``(bb) The physician holds an
addiction certification from the
American Society of Addiction Medicine.
``(cc) The physician holds a board
certification in addiction medicine
from the American Osteopathic
Association.
``(dd) The physician holds a board
certification from the American Board
of Addiction Medicine.
``(ee) The physician has completed
not less than 8 hours of training
(through classroom situations, seminar
at professional society meetings,
electronic communications, or
otherwise) with respect to the
treatment and management of opiate-
dependent patients for substance use
disorders provided by the American
Society of Addiction Medicine, the
American Academy of Addiction
Psychiatry, the American Medical
Association, the American Osteopathic
Association, the American Psychiatric
Association, or any other organization
that the Secretary determines is
appropriate for purposes of this
subclause.
``(ff) The physician has
participated as an investigator in 1 or
more clinical trials leading to the
approval of a narcotic drug in schedule
III, IV, or V for maintenance or
detoxification treatment, as
demonstrated by a statement submitted
to the Secretary by this sponsor of
such approved drug.
``(gg) The physician has such other
training or experience as the Secretary
determines will demonstrate the ability
of the physician to treat and manage
opiate-dependent patients.
``(II) A nurse practitioner or physician
assistant who is licensed under State law and
meets all of the following conditions:
``(aa) The nurse practitioner or
physician assistant is licensed under
State law to prescribe schedule III,
IV, or V medications for pain.
``(bb) The nurse practitioner or
physician assistant satisfies 1 or more
of the following:
``(AA) Has completed not
fewer than 24 hours of training
(through classroom situations,
seminar at professional society
meetings, electronic
communications, or otherwise)
with respect to the treatment
and management of opiate-
dependent patients for
substance use disorders
provided by the American
Society of Addiction Medicine,
the American Academy of
Addiction Psychiatry, the
American Medical Association,
the American Osteopathic
Association, the American
Psychiatric Association, or any
other organization that the
Secretary determines is
appropriate for purposes of
this subclause.
``(BB) Has such other
training or experience as the
Secretary determines will
demonstrate the ability of the
nurse practitioner or physician
assistant to treat and manage
opiate-dependent patients.
``(cc) The nurse practitioner or
physician assistant practices under the
supervision of a licensed physician who
holds an active waiver to prescribe
schedule III, IV, or V narcotic
medications for opioid addiction
therapy, and--
``(AA) the supervising
physician satisfies the
conditions of item (aa), (bb),
(cc), or (dd) of subclause (I);
or
``(BB) both the supervising
physician and the nurse
practitioner or physician
assistant practice in a
qualified practice setting.
``(III) A nurse practitioner who is
licensed under State law and meets all of the
following conditions:
``(aa) The nurse practitioner is
licensed under State law to prescribe
schedule III, IV, or V medications for
pain.
``(bb) The nurse practitioner has
training or experience that the
Secretary determines demonstrates
specialization in the ability to treat
opiate-dependent patients, such as a
certification in addiction specialty
accredited by the American Board of
Nursing Specialties or the National
Commission for Certifying Agencies, or
a certification in addiction nursing as
a Certified Addiction Registered
Nurse--Advanced Practice.
``(cc) In accordance with State
law, the nurse practitioner prescribes
opioid addiction therapy in
collaboration with a physician who
holds an active waiver to prescribe
schedule III, IV, or V narcotic
medications for opioid addiction
therapy.
``(dd) The nurse practitioner
practices in a qualified practice
setting.''; and
(2) by adding at the end the following:
``(iii) The term `qualified practice setting' means
1 or more of the following treatment settings:
``(I) A National Committee for Quality
Assurance-recognized Patient-Centered Medical
Home or Patient-Centered Specialty Practice.
``(II) A Centers for Medicaid & Medicare
Services-recognized Accountable Care
Organization.
``(III) A clinical facility administered by
the Department of Veterans Affairs, Department
of Defense, or Indian Health Service.
``(IV) A Behavioral Health Home accredited
by the Joint Commission.
``(V) A Federally-qualified health center
(as defined in section 1905(l)(2)(B) of the
Social Security Act (42 U.S.C. 1396d(l)(2)(B)))
or a Federally-qualified health center look-
alike.
``(VI) A Substance Abuse and Mental Health
Services-certified Opioid Treatment Program.
``(VII) A clinical program of a State or
Federal jail, prison, or other facility where
individuals are incarcerated.
``(VIII) A clinic that demonstrates
compliance with the Model Policy on DATA 2000
and Treatment of Opioid Addiction in the
Medical Office issued by the Federation of
State Medical Boards.
``(IX) A treatment setting that is part of
an Accreditation Council for Graduate Medical
Education, American Association of Colleges of
Osteopathic Medicine, or American Osteopathic
Association-accredited residency or fellowship
training program.
``(X) Any other practice setting approved
by a State regulatory board or State Medicaid
Plan to provide addiction treatment services.
``(XI) Any other practice setting approved
by the Secretary.''.
SEC. 5. GAO EVALUATION.
Two years after the date on which the first notification under
clause (iv) of section 303(g)(2)(B) of the Controlled Substances Act
(21 U.S.C. 823(g)(2)(B)), as added by this Act, is received by the
Secretary of Health and Human Services, the Comptroller General of the
United States shall initiate an evaluation of the effectiveness of the
amendments made by this Act, which shall include an evaluation of--
(1) any changes in the availability and use of medication-
assisted treatment for opioid addiction;
(2) the quality of medication-assisted treatment programs;
(3) the integration of medication-assisted treatment with
routine healthcare services;
(4) diversion of opioid addiction treatment medication;
(5) changes in State or local policies and legislation
relating to opioid addiction treatment;
(6) the use of nurse practitioners and physician assistants
who prescribe opioid addiction medication;
(7) the use of Prescription Drug Monitoring Programs by
waived practitioners to maximize safety of patient care and
prevent diversion of opioid addiction medication;
(8) the findings of Drug Enforcement Agency inspections of
waived practitioners, including the frequency with which the
Drug Enforcement Agency finds no documentation of access to
behavioral health services; and
(9) the effectiveness of cross-agency collaboration between
Department of Health and Human Services and the Drug
Enforcement Agency for expanding effective opioid addiction
treatment.
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