H. Rept. 115-760 - EXPANDING OVERSIGHT OF OPIOID PRESCRIBING AND PAYMENT ACT OF 2018115th Congress (2017-2018)
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115th Congress } { Rept. 115-760
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
EXPANDING OVERSIGHT OF OPIOID PRESCRIBING AND PAYMENT ACT OF 2018
_______
June 19, 2018.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Brady of Texas, from the Committee on Ways and Means, submitted the
following
R E P O R T
[To accompany H.R. 5723]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 5723) to require the Medicare Payment Advisory
Commission to report on opioid payment, adverse incentives, and
data under the Medicare program, having considered the same,
report favorably thereon with an amendment and recommend that
the bill as amended do pass.
CONTENTS
Page
I. SUMMARY AND BACKGROUND............................................2
A. Purpose and Summary................................... 2
B. Background and Need for Legislation................... 2
C. Legislative History................................... 3
II. EXPLANATION OF THE BILL...........................................3
A. Expanding Oversight of Opioid Prescribing and Payment
Act.................................................. 3
III.VOTES OF THE COMMITTEE............................................4
IV. BUDGET EFFECTS OF THE BILL........................................4
A. Committee Estimate of Budgetary Effects............... 4
B. Statement Regarding New Budget Authority and Tax
Expenditures Budget Authority........................ 4
C. Cost Estimate Prepared by the Congressional Budget
Office............................................... 4
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE.......13
A. Committee Oversight Findings and Recommendations...... 13
B. Statement of General Performance Goals and Objectives. 13
C. Information Relating to Unfunded Mandates............. 13
D. Congressional Earmarks, Limited Tax Benefits, and
Limited Tariff Benefits.............................. 13
E. Duplication of Federal Programs....................... 13
F. Disclosure of Directed Rule Makings................... 13
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Expanding Oversight of Opioid
Prescribing and Payment Act of 2018''.
SEC. 2. MEDICARE PAYMENT ADVISORY COMMISSION REPORT ON OPIOID PAYMENT,
ADVERSE INCENTIVES, AND DATA UNDER THE MEDICARE
PROGRAM.
Not later than March 15, 2019, the Medicare Payment Advisory
Commission shall submit to Congress a report on, with respect to the
Medicare program under title XVIII of the Social Security Act, the
following:
(1) A description of how the Medicare program pays for pain
management treatments (both opioid and non-opioid pain
management alternatives) in both inpatient and outpatient
hospital settings.
(2) The identification of incentives under the hospital
inpatient prospective payment system under section 1886 of the
Social Security Act (42 U.S.C. 1395ww) and incentives under the
hospital outpatient prospective payment system under section
1833(t) of such Act (42 U.S.C. 1395l(t)) for prescribing
opioids and incentives under each such system for prescribing
non-opioid treatments, and recommendations as the Commission
deems appropriate for addressing any of such incentives that
are adverse incentives.
(3) A description of how opioid use is tracked and monitored
through Medicare claims data and other mechanisms and the
identification of any areas in which further data and methods
are needed for improving data and understanding of opioid use.
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
The bill, H.R. 5723, the ``Expanding Oversight of Opioid
Prescribing and Payment Act of 2018'' as ordered reported by
the Committee on Ways and Means on May 16, 2018, requires that
by March 15, 2019, the Medicare Payment Advisory Commission
(MedPAC) submit a report to Congress that describes: (1) how
the Medicare Program pays for pain management treatment options
in a hospital setting; (2) incentives under Medicare hospital
payments for prescribing opioids relative to non-opioid
alternatives; and (3) how opioid use may be tracked through
Medicare claims data. MedPAC will also identify areas in which
further data/methods are needed to fully understand opioid
utilization patterns in Medicare. If appropriate, MedPAC will
issue recommendations for addressing any adverse incentives in
the hospital payment system related to opioid vs. non-opioid
prescribing.
B. Background and Need for Legislation
Providers often have a choice regarding the types of
medicines or other items used in a procedure for a patient. One
such choice centers around the type of medication provided to
the patient during and after a procedure. Medicare payments
should be neutral, encouraging providers to select the items
and services most appropriate for a given patient. Sometimes,
payment incentives in Medicare become misaligned, potentially
providing a financial incentive to choose one item over
another. Stakeholder responses to the February 27, 2018 request
for information (RFI) letter from the Ways and Means Committee,
as well as the Christie Commission Final Report, indicated that
there are likely financial incentives in the Medicare hospital
payment system that cause overprescribing of opioids.
C. Legislative History
Background
H.R. 5723 was introduced on May 11, 2018, and was referred
to the Committee on Ways and Means and additionally the
Committee on Energy and Commerce.
Committee hearings
On January 17, 2018, the Subcommittee on Oversight held a
hearing on the current landscape and CMS actions to prevent
opioid misuse.
On February 6, 2018, the Subcommittee on Health held a
hearing on removing barriers to prevent and treat opioid abuse
and dependence in Medicare.
On April 12, 2018, the Subcommittee on Human Resources held
a hearing on local perspective on the jobs gap that discussed
problems the opioid epidemic is creating in finding qualified
workers.
On April 25, 2018, the Subcommittee on Trade held a hearing
on stopping the flow of synthetic opioids in the international
mail system.
Committee action
The Committee on Ways and Means marked up H.R. 5723, the
``Expanding Oversight of Opioid Prescribing and Payment Act of
2018,'' on May 16, 2018, and ordered the bill, as amended,
favorably reported (with a quorum being present) by voice vote.
II. EXPLANATION OF THE BILL
A. ``Expanding Oversight of Opioid Prescribing and Payment Act of
2018''
PRESENT LAW
The Medicare Payment Advisory Commission (MedPAC) may study
topics of interest to the Commissioners but may also be
directed by Congress to study a specific matter.
REASONS FOR CHANGE
This bill requires MedPAC to study and make recommendations
regarding Medicare payment for pain management, reducing
adverse financial incentives to prescribe opioids, and tracking
opioid prescribing data through Medicare claims.
EXPLANATION OF PROVISIONS
Section 1: This section states the short title as the
``Expanding Oversight of Opioid Prescribing and Payment Act of
2018.''
Section 2: Medicare Payment Advisory Commission Report on
Opioid Payment, Adverse Incentives, and Data under the Medicare
Program.
By March 15, 2019, the Medicare Payment Advisory Commission
(MedPAC) is required to submit a report to Congress that
describes: (1) how the Medicare Program pays for pain
management treatment options in a hospital setting; (2)
incentives under Medicare hospital payments for prescribing
opioids relative to non-opioid alternatives; and (3) how opioid
use may be tracked through Medicare claims data. MedPAC will
also identify areas in which further data/methods are needed to
fully understand opioid utilization patterns in Medicare. If
appropriate, MedPAC will issue recommendations for addressing
any adverse incentives in the hospital payment system related
to opioid vs. non-opioid prescribing.
EFFECTIVE DATE
Medicare Payment Advisory Commission Report on Opioid
Payment, Adverse Incentives, and Data under the Medicare
Program: MedPAC is required to report to Congress by March 15,
2019.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the vote of the Committee on Ways and Means in its
consideration of H.R. 5723, the Expanding Oversight of Opioid
Prescribing and Payment Act, on May 16, 2018.
The Chairman's amendment in the nature of a substitute was
adopted by a voice vote (with a quorum being present).
The bill, H.R. 5723, was ordered favorably reported as
amended by voice vote (with a quorum being present).
IV. BUDGET EFFECTS OF THE BILL
A. Committee Estimate of Budgetary Effects
In compliance with clause 3(d) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the effects on the budget of the bill, H.R. 5723, as
reported. The Committee agrees with the estimate prepared by
the Congressional Budget Office (CBO), which is included below.
B. Statement Regarding New Budget Authority and Tax Expenditures Budget
Authority
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee states that the
bill involves no new or increased budget authority. The
Committee states further that the bill involves no new or
increased tax expenditures.
C. Cost Estimate Prepared by the Congressional Budget Office
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, requiring a cost estimate
prepared by the CBO, the following statement by CBO is
provided.
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 6, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for the opioid-related
legislation ordered to be reported on May 16, 2018.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Tom Bradley.
Sincerely,
Mark P. Hadley
(For Keith Hall).
Enclosure.
Opioid Legislation
Summary: On May 16, 2018, the House Committee on Ways and
Means ordered seven bills to be reported related to the
nation's response to the opioid epidemic. Generally, the bills
would:
Expand Medicare coverage of treatment for
opioid use disorder;
Give Medicare providers and health plans
additional tools to curtail inappropriate prescribing
and use of opioids;
Require the completion of studies and
reports related to opioid use and misuse in Medicare;
and
Require the United States Postal Service and
Customs and Border Protection (CBP) to reduce illegal
shipment of opioids across international borders.
Because the bills are related, CBO is publishing a single
comprehensive document that includes estimates for each piece
of legislation.
CBO estimates that enacting four of the bills would affect
direct spending; therefore, pay-as-you-go procedures apply for
those bills. None of the bills would affect revenues.
CBO estimates that although enacting one bill of the seven
included in this document (H.R. 5776) would increase net direct
spending and on-budget deficits over the four consecutive 10-
year periods beginning in 2029, those effects would not exceed
the threshold established by the Congress for long-term costs.
CBO estimates that none of the remaining bills would increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2029.
None of the bills contain intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act
(UMRA).
Estimated cost to the Federal Government: The estimates in
this document do not include the effects of interactions among
the bills. If all seven bills were combined and enacted as one
piece of legislation, the budgetary effects would be different
from the sum of the estimates in this document, although CBO
expects that those differences would be small. The effects of
this legislation fall within functions 550 (health), 570
(Medicare), and 750 (administration of justice).
Basis of estimate: For this estimate, CBO assumes that all
of the legislation will be enacted late in 2018 and that
authorized and estimated amounts will be appropriated each
year. Outlays for discretionary programs are estimated based on
historical spending patterns for similar programs.
Uncertainty
CBO aims to produce estimates that generally reflect the
middle of a range of the most likely budgetary outcomes that
would result if the legislation was enacted. Because data on
the utilization of mental health and substance abuse treatment
under Medicaid and Medicare is scarce, CBO cannot precisely
predict how patients or providers would respond to some policy
changes or what budgetary effects would result. In addition,
several of the bills would give the Department of Health and
Human Services (HHS) considerable latitude in designing and
implementing policies. Budgetary effects could differ from
those provided in CBO's analyses depending on those decisions.
Direct Spending
Table 1 lists the four bills included in this estimate that
would affect direct spending.
H.R. 5676, the Stop Excessive Narcotics in our Retirement
Communities Protection Act of 2018, would allow prescription
drug plans to suspend payments to pharmacies while fraud
investigations are pending. CBO expects that enacting the
legislation would reduce payments by those plans to pharmacies
and result in lower premiums for benefits under Medicare's Part
D. CBO estimates that the reduction in premiums would lower
federal spending for Part D by $9 million over the 2019-2028
period.
TABLE 1.--ESTIMATED CHANGES IN MANDATORY SPENDING
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
------------------------------------------------------------------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019-2023 2019-2028
--------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES OR DECREASES (-) IN DIRECT SPENDING
H.R. 5676, Stop Excessive
Narcotics in our Retirement
Communities Protection Act of
2018:
Budget Authority........... 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -4 -9
Outlays.................... 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -4 -9
H.R. 5773, Preventing Addiction
for Susceptible Seniors Act of
2018:a
Budget Authority........... 0 0 0 -6 -7 -7 -7 -8 -9 -9 -11 -20 -64
Outlays.................... 0 0 0 -6 -7 -7 -7 -8 -9 -9 -11 -20 -64
H.R. 5776, the Medicare and
Opioid Safe Treatment Act of
2018:a
Budget Authority........... 0 8 0 20 20 25 30 30 35 35 40 73 243
Outlays.................... 0 2 4 22 20 25 30 30 35 35 40 73 243
H.R. 5788, Securing the
International Mail Against
Opioids Act of 2018:a
Budget Authority........... 0 0 * * * * * * * * * * *
Outlays.................... 0 0 * * * * * * * * * * *
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual amounts may not sum to totals because of rounding. * = between -$500,000 and $500,000
aThis bill also would affect spending subject to appropriation.
H.R. 5773, the Preventing Addiction for Susceptible Seniors
Act of 2018, would require Part D prescription drug plans to
provide drug management programs for Medicare beneficiaries who
are at risk for prescription drug abuse. (Under current law,
Part D plans are permitted but not required to establish such
programs as of 2019.) Based on an analysis of the number of
plans currently providing those programs, CBO estimates that
enacting H.R. 5773 would lower federal spending by $64 million
over the 2019-2028 period by reducing the number of
prescriptions filled and Medicare's payments for controlled
substances.
Two provisions of H.R. 5773 would have no significant
budgetary effect; they are described later in this document.
H.R. 5776, the Medicare and Opioid Safe Treatment Act of
2018, would appropriate $8 million in 2019, which would be
available until expended, for Federally Qualified Health
Centers and Rural Health Clinics to support training in the
treatment of opioid use disorder. CBO expects that $8 million
would be spent between 2019 and 2021.
H.R. 5776 also would expand the availability of medication-
assisted treatment (MAT) for Medicare beneficiaries with opioid
use disorder. The bill would allow treatment programs certified
by the Substance Abuse and Mental Health Services
Administration (SAMHSA) to become Medicare-participating
providers.\1\ H.R. 5776 also would direct the Secretary of HHS
to create a new schedule of bundled payments for MAT through
certified programs and grant the Secretary considerable
discretion for defining bundles and establishing payment rates.
---------------------------------------------------------------------------
\1\MAT combines behavioral therapy and pharmaceutical treatment for
substance use disorders. Under current law, methadone (an opioid used
to treat and manage dependence on other drugs, such as heroin) can be
dispensed only by SAMHSA-certified treatment programs, which do not
participate in Medicare. Other drugs used in MAT, including
buprenorphine and naltrexone, can be dispensed more widely.
---------------------------------------------------------------------------
CBO projects that, beginning in 2021, about 3,000 Medicare
beneficiaries who would not be-treated for opioid abuse under
current law would newly enroll each year in treatment offered
by SAMHSA-certified programs and that the annual cost per
participant would range from about $6,000 to about $10,000,
depending largely on the medications dispensed and the period
for which beneficiaries adhered to the protocol. CBO's
projection of the number of beneficiaries who would receive
treatment takes into consideration the number of beneficiaries
estimated to have opioid-use disorder, the number already
receiving some form of treatment, and the availability of
providers to treat those who newly enroll in MAT. To develop a
per capita treatment cost, CBO analyzed rates for MAT paid by
other payers, as well as Medicare spending for health care
services typically used by people receiving MAT. CBO estimates
that the new MAT benefit would increase direct spending by $235
million over the 2019-2028 period.
CBO estimates that enacting H.R. 5776 would increase net
Medicare spending by $243 million over the 2019-2028 period.
(If enacted, H.R. 5776 would also affect spending subject to
appropriation; CBO has not completed an estimate of that
amount.)
H.R. 5788, the Securing the International Mail Against
Opioids Act of 2018, would establish a new fee for certain
items mailed to the United States from overseas, beginning
January 1, 2020. Initially, the fee for most such items would
be one dollar, but the amount could be adjusted annually
thereafter. Using information provided by CBP, CBO estimates
that about $100 million in new fees would be collected over the
2020-2028 period. The collections would be divided equally
between CBP and the Postal Service and spent by those agencies
on activities related to the processing of inbound mail. CBO
estimates that the net effect on federal spending in each year
would be insignificant. (If enacted, H.R. 5788 would also
affect spending subject to appropriation; those effects are
described below.)
Spending Subject to Appropriation
For this document, CBO has grouped bills with spending that
would be subject to appropriation into three general
categories:
Bills with provisions that would have no
budgetary effect;
Bills with provisions for which CBO has
estimated an authorization of appropriations (see Table
2); and
Bills with provisions that would affect
spending subject to appropriation for which CBO has not
yet completed an estimate.
No Budgetary Effect. CBO estimates that three of the bills
have provisions that would not significantly affect direct
spending, revenues, or spending subject to appropriation.
H.R. 5773, the Preventing Addiction for Susceptible Seniors
Act of 2018, would require health care professionals to submit
prior authorization requests electronically, starting on
January 1, 2021, for drugs covered under Medicare Part D.
Taking into account that many prescribers already use
electronic methods to submit such requests, CBO estimates that
enacting that Section 3 of H.R. 5773 would not significantly
affect direct spending for Part D.
Section 5 of that bill would expand medication therapy
management programs under Medicare Part D to include
beneficiaries who are at risk for prescription drug abuse.
Because relatively few beneficiaries would be affected by this
provision, CBO estimates that its enactment would not
significantly affect direct spending for Part D.
Section 6 of that bill would require the Secretary of HHS
on an annual basis to identify high prescribers of opioids and
furnish them with information about proper prescribing methods.
Because HHS already has the capacity to meet those
requirements, CBO estimates that enacting that provision would
not impose additional administrative costs on the agency.
H.R. 5775, the Providing Reliable Options for Patients and
Educational Resources Act of 2018, would require prescription
drug plans that provide coverage under Medicare Part D to
furnish information to beneficiaries about the risks of opioid
use and the availability of alternative treatments for pain.
The bill also would require Medicare Advantage plans and
prescription drug plans to provide information regarding safe
disposal of controlled substances in home health risk
assessments and medication therapy management programs,
respectively. In CBO's estimation, neither proposal would have
a budgetary effect because those activities would not impose
significant administrative costs on plans or federal agencies.
In addition, H.R. 5775 would restrict the use of certain
pain-related questions on the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) survey, which is
administered by the Centers for Medicare & Medicaid Services
(CMS). The survey is one measure used in CMS's Hospital Value-
Based Purchasing (VBP) Program, which adjusts payments to acute
care hospitals on the basis of the quality of care they provide
to Medicare beneficiaries. Because the VBP program is funded by
reducing base payments to all hospitals, CBO estimates that
changing the HCAHPS survey would not affect the total amount
paid by Medicare.
H.R. 5776, the Medicare and Opioid Safe Treatment Act of
2018, in section 3, would require CMS, beginning on January 1,
2020, to review and possibly modify payments made through
Medicare's Hospital Outpatient Prospective Payment System for
certain opioid and nonopioid pain management treatments and
technologies. CMS could revise payments if the Secretary of HHS
determined that there was a financial incentive to use opioids
in place of nonopioid medications. The budget neutrality
requirement under current law would apply to such revisions,
and the rest of the payment rates within the system would be
subject to offsetting adjustments. Because the changes would be
made in a budget-neutral manner, CBO estimates that this
provision would have no budgetary effect.
Section 6 of H.R. 5776 would explicitly authorize the
Center for Medicare and Medicaid Innovation (CMMI) to test
approaches for expanding beneficiaries' awareness of
psychological services and to help those beneficiaries curtail
use of hospital-based mental health or behavioral health
services. Because CMMI already has that authority, CBO
estimates that enacting the legislation would not affect
federal spending.
Estimated Authorizations. Table 2 shows CBO's estimates of
the authorization of appropriations for provisions in four
bills. For those estimates, CBO assumes that appropriated funds
would be available to implement those provisions.
H.R. 5723, the Expanding Oversight of Opioid Prescribing
and Payment Act of 2018, would require the Medicare Payment
Advisory Commission to report to the Congress on payments for
pain treatment, incentives for prescribing opioids in inpatient
and outpatient settings, and documented tracking of opioid use
from Medicare claims data. CBO estimates that producing such a
report would cost less than $500,000 over the 2019-2023 period.
TABLE 2.--ESTIMATED SPENDING SUBJECT TO APPROPRIATION FOR BILLS WITH ESTIMATED AUTHORIZATIONS
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------------
2018 2019 2020 2021 2022 2023 2019-2023
----------------------------------------------------------------------------------------------------------------
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
H.R. 5723, Expanding Oversight of Opioid
Prescribing and Payment Act of 2018:
Estimated Authorization Level.............. 0 * 0 0 0 0 *
Estimated Outlays.......................... 0 * 0 0 0 0 *
H.R. 5773, Preventing Addiction for Susceptible
Seniors Act of 2018:a
Estimated Authorization Level.............. 0 2 2 2 2 2 9
Estimated Outlays.......................... 0 2 2 2 2 2 9
H.R. 5776, Medicare and Opioid Safe Treatment
Act of 2018:a
Estimated Authorization Level.............. 0 1 0 0 0 0 1
Estimated Outlays.......................... 0 1 0 0 0 0 1
H.R. 5788, Securing the International Mail
Against Opioids Act of 2018:a
Estimated Authorization Level.............. 0 100 0 0 0 0 100
Estimated Outlays.......................... 0 40 40 20 0 0 100
----------------------------------------------------------------------------------------------------------------
Annual amounts may not sum to totals because of rounding. * = between zero and $500,000
aThis bill also would affect mandatory spending
H.R. 5773, the Preventing Addiction for Susceptible Seniors
Act of 2018, would require the Secretary of HHS to establish a
secure Internet portal to allow HHS, Medicare Advantage plans,
and Medicare Part D plans to exchange information about fraud,
waste, and abuse among providers and suppliers no later than
two years after enactment. H.R. 5773 also would require
organizations with Medicare Advantage contracts to submit
information on investigations related to providers suspected of
prescribing large volumes of opioids through a process
established by the Secretary no later than January 2021. Based
on historical spending patterns for similar activities, CBO
estimates that implementing H.R. 5773 would cost approximately
$9 million over the 2019-2023 period.
H.R. 5776, the Medicare and Opioid Safe Treatment Act of
2018, would direct the Secretary of HHS to report to the
Congress on the availability of supplemental benefits to pay
for treatment or prevention of substance abuse among enrollees
in Medicare Advantage plans. The Secretary also would report on
coverage of and payment for pain treatment and substance use
disorders under Medicare. CBO estimates that producing those
reports would cost $1 million over five years.
H.R. 5788, the Securing the International Mail Against
Opioids Act of 2018, would direct the Postal Service, CBP, and
other federal agencies to collaborate to develop technology to
detect opioids and other drugs that enter the United States in
the mail. Using information provided by CBP, CBO estimates that
it would cost roughly $100 million over the 2019-2021 period to
deploy drug detection systems at international mail facilities.
Other Authorizations. CBO has determined that provisions in
two bills--H.R. 5774, Combating Opioid Abuse for Care in
Hospitals Act of 2018; and H.R. 5776, the Medicare and Safe
Opioid Treatment Act of 2018--would increase authorization
levels, but has not completed estimates of amounts. Any
spending that would result from those authorizations would be
subject to future appropriation action.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. Four of the bills discussed in this document contain
direct spending and are subject to pay-as-you-go procedures.
Details about the amount of direct spending in those bills can
be found in Table 1.
Increase in long-term direct spending and deficits: CBO
estimates that although enacting H.R. 5776, the Medicare and
Opioid Safe Treatment Act of 2018, would increase net direct
spending and on-budget deficits over the four consecutive 10-
year periods beginning in 2029, those effects would not exceed
the threshold established by the Congress for long-term costs
($2.5 billion for net direct spending and $5 billion for on-
budget deficits). CBO estimates that none of the remaining
bills would increase net direct spending or on-budget deficits
in any of the four consecutive 10-year periods beginning in
2029.
Mandates: None of the bills contains intergovernmental or
private-sector mandates as defined in UMRA.
Previous CBO estimate: On June 6, 2018, CBO issued an
estimate for 59 opioid-related bills ordered reported by the
House Committee on Energy and Commerce on May 9 and May 17,
2018. Several of those bills contain provisions that are
identical or similar to those in the legislation ordered
reported by the Committee on Ways and Means, and for those
provisions, CBO's estimates are the same.
In particular, several sections in H.R. 5773, the
Preventing Addiction for Susceptible Seniors Act of 2018,
contain provisions that are identical or similar to those in
five bills listed in the other estimate:
Section 2, which would require prescription
drug plans to implement drug management programs, is
identical to a provision in H.R. 5675.
Section 3, regarding electronic prior
authorization for prescriptions under Medicare's Part
D, is similar to a provision in H.R. 4841.
Section 4, which would mandate the creation
of a new Internet portal to allow various stakeholders
to exchange information, is identical to a provision in
H.R. 5715.
Section 5, which would expand medication
therapy management, is the same as a provision in H.R.
5684.
Section 6, regarding prescriber
notification, is identical to H.R. 5716.
In addition, in this estimate, a provision related to
Medicare beneficiary education in section 2 of H.R. 5775, the
Providing Reliable Options for Patients and Educational
Resources Act of 2018, is the same as a provision in H.R. 5686,
the Medicare Clear Health Options in Care for Enrollees Act of
2018, in CBO's estimate for the Committee on Energy and
Commerce.
Estimate prepared by: Federal Costs Medicare: Philippa
Haven, Lori Housman, Jamease Kowalczyk, Lara Robillard, Sarah
Sajewski, Colin Yee, and Rebecca Yip. U.S. Postal Service and
Customs and Border Protection: Mark Grabowicz; Mandates: Andrew
Laughlin; Fact Checking: Zachary Byrum and Kate Kelly.
Estimate reviewed by: Tom Bradley, Chief, Health Systems
and Medicare Cost Estimates Unit; Kim P. Cawley, Chief, Natural
Resources Cost Estimates Unit; Susan Willie, Chief, Mandates
Unit; Leo Lex, Deputy Assistant Director for Budget Analysis;
Theresa A. Gullo, Assistant Director for Budget Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
With respect to clause 3(c)(1) of rule XIII of the Rules of
the House of Representatives, the Committee made findings and
recommendations that are reflected in this report.
B. Statement of General Performance Goals and Objectives
With respect to clause 3(c)(4) of rule XIII of the Rules of
the House of Representatives, the Committee advises that the
bill contains no measure that authorizes funding, so no
statement of general performance goals and objectives for which
any measure authorizes funding is required.
C. Information Relating to Unfunded Mandates
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
The Committee has determined that the bill does not contain
Federal mandates on the private sector. The Committee has
determined that the bill does not impose a Federal
intergovernmental mandate on State, local, or tribal
governments.
D. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff
Benefits
With respect to clause 9 of rule XXI of the Rules of the
House of Representatives, the Committee has carefully reviewed
the provisions of the bill, and states that the provisions of
the bill do not contain any congressional earmarks, limited tax
benefits, or limited tariff benefits within the meaning of the
rule.
E. Duplication of Federal Programs
In compliance with Sec. 3(g)(2) of H. Res. 5 (114th
Congress), the Committee states that no provision of the bill
establishes or reauthorizes: (1) a program of the Federal
Government known to be duplicative of another Federal program;
(2) a program included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139; or (3) a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance, published pursuant to the Federal Program
Information Act (Pub. L. No. 95-220, as amended by Pub. L. No.
98-169).
F. Disclosure of Directed Rule Makings
In compliance with Sec. 3(i) of H. Res. 5 (114th Congress),
the following statement is made concerning directed rule
makings: The Committee estimates that the bill requires no
directed rule makings within the meaning of such section.
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