114TH CONGRESS 

2D SESSION H. R. 4063 

AN ACT 

To improve the use by the Secretary of Veterans Affairs 

of opioids in treating veterans, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Promoting Responsible 

3 Opioid Management and Incorporating Scientific Exper4 tise Act’’ or the ‘‘Jason Simcakoski PROMISE Act’’. 

5 SEC. 2. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 

6 DEPARTMENT OF VETERANS AFFAIRS. 

7 (a) EXPANSION OF OPIOID SAFETY INITIATIVE.— 

8 (1) INCLUSION OF ALL MEDICAL FACILITIES.— 

9 Not later than 180 days after the date of the enact10 ment of this Act, the Secretary of Veterans Affairs 

11 shall expand the Opioid Safety Initiative of the De12 partment of Veterans Affairs to include all medical 

13 facilities of the Department. 

14 (2) GUIDANCE.—The Secretary shall establish 

15 guidance that each health care provider of the De16 partment of Veterans Affairs, before initiating opioid 

17 therapy to treat a patient as part of the comprehen18 sive assessment conducted by the health care pro19 vider, use the Opioid Therapy Risk Report tool of 

20 the Department of Veterans Affairs (or any subse21 quent tool), which shall include information from the 

22 prescription drug monitoring program of each par23 ticipating State as applicable, that includes the most 

24 recent information to date relating to the patient 

25 that accessed such program to assess the risk for 

26 adverse outcomes of opioid therapy for the patient, 
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1 including the concurrent use of controlled substances 

2 such as benzodiazepines, as part of the comprehen3 sive assessment conducted by the health care pro4 vider. 

5 (3) ENHANCED STANDARDS.—The Secretary 

6 shall establish enhanced standards with respect to 

7 the use of routine and random urine drug tests for 

8 all patients before and during opioid therapy to help 

9 prevent substance abuse, dependence, and diversion, 

10 including— 

11 (A) that such tests occur not less fre12 quently than once each year; and 

13 (B) that health care providers appro14 priately order, interpret and respond to the re15 sults from such tests to tailor pain therapy, 

16 safeguards, and risk management strategies to 

17 each patient. 

18 (b) PAIN MANAGEMENT EDUCATION AND TRAIN19 ING.— 

20 (1) IN GENERAL.—In carrying out the Opioid 

21 Safety Initiative of the Department, the Secretary 

22 shall require all employees of the Department re23 sponsible for prescribing opioids to receive education 

24 and training described in paragraph (2). 
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1 (2) EDUCATION AND TRAINING.—Education 

2 and training described in this paragraph is edu3 cation and training on pain management and safe 

4 opioid prescribing practices for purposes of safely 

5 and effectively managing patients with chronic pain, 

6 including education and training on the following: 

7 (A) The implementation of and full compli8 ance with the VA/DOD Clinical Practice Guide9 line for Management of Opioid Therapy for 

10 Chronic Pain, including any update to such 

11 guideline. 

12 (B) The use of evidence-based pain man13 agement therapies, including cognitive-behav14 ioral therapy, non-opioid alternatives, and non15 drug methods and procedures to managing pain 

16 and related health conditions including medical 

17 devices approved or cleared by the Food and 

18 Drug Administration for the treatment of pa19 tients with chronic pain and complementary al20 ternative medicines. 

21 (C) Screening and identification of patients 

22 with substance use disorder, including drug23 seeking behavior, before prescribing opioids, as24 sessment of risk potential for patients devel25 oping an addiction, and referral of patients to 
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1 appropriate addiction treatment professionals if 

2 addiction is identified or strongly suspected. 

3 (D) Communication with patients on the 

4 potential harm associated with the use of 

5 opioids and other controlled substances, includ6 ing the need to safely store and dispose of sup7 plies relating to the use of opioids and other 

8 controlled substances. 

9 (E) Such other education and training as 

10 the Secretary considers appropriate to ensure 

11 that veterans receive safe and high-quality pain 

12 management care from the Department. 

13 (3) USE OF EXISTING PROGRAM.—In providing 

14 education and training described in paragraph (2), 

15 the Secretary shall use the Interdisciplinary Chronic 

16 Pain Management Training Team Program of the 

17 Department (or success program). 

18 (c) PAIN MANAGEMENT TEAMS.— 

19 (1) IN GENERAL.—In carrying out the Opioid 

20 Safety Initiative of the Department, the director of 

21 each medical facility of the Department shall iden22 tify and designate a pain management team of 

23 health care professionals, which may include board 

24 certified pain medicine specialists, responsible for co25 ordinating and overseeing pain management therapy 
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1 at such facility for patients experiencing acute and 

2 chronic pain that is non-cancer related. 

3 (2) ESTABLISHMENT OF PROTOCOLS.— 

4 (A) IN GENERAL.—In consultation with 

5 the Directors of each Veterans Integrated Serv6 ice Network, the Secretary shall establish 

7 standard protocols for the designation of pain 

8 management teams at each medical facility 

9 within the Department. 

10 (B) CONSULTATION ON PRESCRIPTION OF

11 OPIOIDS.—Each protocol established under sub12 paragraph (A) shall ensure that any health care 

13 provider without expertise in prescribing anal14 gesics or who has not completed the education 

15 and training under subsection (b), including a 

16 mental health care provider, does not prescribe 

17 opioids to a patient unless that health care pro18 vider— 

19 (i) consults with a health care pro20 vider with pain management expertise or 

21 who is on the pain management team of 

22 the medical facility; and 

23 (ii) refers the patient to the pain man24 agement team for any subsequent prescrip25 tions and related therapy. 
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1 (3) REPORT.— 

2 (A) IN GENERAL.—Not later than 1 year 

3 after the date of enactment of this Act, the di4 rector of each medical facility of the Depart5 ment shall submit to the Under Secretary for 

6 Health and the director of the Veterans Inte7 grated Service Network in which the medical fa8 cility is located a report identifying the health 

9 care professionals that have been designated as 

10 members of the pain management team at the 

11 medical facility pursuant to paragraph (1). 

12 (B) ELEMENTS.—Each report submitted 

13 under subparagraph (A) with respect to a med14 ical facility of the Department shall include— 

15 (i) a certification as to whether all 

16 members of the pain management team at 

17 the medical facility have completed the 

18 education and training required under sub19 section (b); 

20 (ii) a plan for the management and 

21 referral of patients to such pain manage22 ment team if health care providers without 

23 expertise in prescribing analgesics pre24 scribe opioid medications to treat acute 
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1 and chronic pain that is non-cancer re2 lated; and 

3 (iii) a certification as to whether the 

4 medical facility— 

5 (I) fully complies with the 

6 stepped-care model of pain manage7 ment and other pain management 

8 policies contained in Directive 2009– 

9 053 of the Veterans Health Adminis10 tration, or successor directive; or 

11 (II) does not fully comply with 

12 such stepped-care model of pain man13 agement and other pain management 

14 policies but is carrying out a correc15 tive plan of action to ensure such full 

16 compliance. 

17 (d) TRACKING AND MONITORING OF OPIOID USE.— 

18 (1) PRESCRIPTION DRUG MONITORING PRO19 GRAMS OF STATES.—In carrying out the Opioid 

20 Safety Initiative and the Opioid Therapy Risk Re21 port tool of the Department, the Secretary shall— 

22 (A) ensure access by health care providers 

23 of the Department to information on controlled 

24 substances, including opioids and 

25 benzodiazepines, prescribed to veterans who re-
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1 ceive care outside the Department through the 

2 prescription drug monitoring program of each 

3 State with such a program, including by seek4 ing to enter into memoranda of understanding 

5 with States to allow shared access of such infor6 mation between States and the Department; 

7 (B) include such information in the Opioid 

8 Therapy Risk Report; and 

9 (C) require health care providers of the 

10 Department to submit to the prescription drug 

11 monitoring program of each State information 

12 on prescriptions of controlled substances re13 ceived by veterans in that State under the laws 

14 administered by the Secretary. 

15 (2) REPORT ON TRACKING OF DATA ON OPIOID

16 USE.—Not later than 18 months after the date of 

17 the enactment of this Act, the Secretary shall submit 

18 to the Committee on Veterans’ Affairs of the Senate 

19 and the Committee on Veterans’ Affairs of the 

20 House of Representatives a report on the feasibility 

21 and advisability of improving the Opioid Therapy 

22 Risk Report tool of the Department to allow for 

23 more advanced real-time tracking of and access to 

24 data on— 
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1 (A) the key clinical indicators with respect 

2 to the totality of opioid use by veterans; 

3 (B) concurrent prescribing by health care 

4 providers of the Department of opioids in dif5 ferent health care settings, including data on 

6 concurrent prescribing of opioids to treat men7 tal health disorders other than opioid use dis8 order; and 

9 (C) mail-order prescriptions of opioid pre10 scribed to veterans under the laws administered 

11 by the Secretary. 

12 (e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO13 NISTS.— 

14 (1) INCREASED AVAILABILITY AND USE.— 

15 (A) IN GENERAL.—The Secretary shall 

16 maximize the availability of opioid receptor an17 tagonists approved by the Food and Drug Ad18 ministration, including naloxone, to veterans. 

19 (B) AVAILABILITY, TRAINING, AND DIS20 TRIBUTING.—In carrying out subparagraph 

21 (A), not later than 90 days after the date of the 

22 enactment of this Act, the Secretary shall— 

23 (i) equip each pharmacy of the De24 partment with opioid receptor antagonists 

25 approved by the Food and Drug Adminis-
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1 tration to be dispensed to outpatients as 

2 needed; and 

3 (ii) expand the Overdose Education 

4 and Naloxone Distribution program of the 

5 Department to ensure that all veterans in 

6 receipt of health care under laws adminis7 tered by the Secretary who are at risk of 

8 opioid overdose may access such opioid re9 ceptor antagonists and training on the 

10 proper administration of such opioid recep11 tor antagonists. 

12 (C) VETERANS WHO ARE AT RISK.—For 

13 purposes of subparagraph (B), veterans who are 

14 at risk of opioid overdose include— 

15 (i) veterans receiving long-term opioid 

16 therapy; 

17 (ii) veterans receiving opioid therapy 

18 who have a history of substance use dis19 order or prior instances of overdose; and 

20 (iii) veterans who are at risk as deter21 mined by a health care provider who is 

22 treating the veteran. 

23 (2) REPORT.—Not later than 120 days after 

24 the date of the enactment of this Act, the Secretary 

25 shall submit to the Committee on Veterans’ Affairs 
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1 of the Senate and the Committee on Veterans’ Af2 fairs of the House of Representatives a report on 

3 carrying out paragraph (1), including an assessment 

4 of any remaining steps to be carried out by the Sec5 retary to carry out such paragraph. 

6 (f) INCLUSION OF CERTAIN INFORMATION AND CA7 PABILITIES IN OPIOID THERAPY RISK REPORT TOOL OF

8 THE DEPARTMENT.— 

9 (1) INFORMATION.—The Secretary shall include 

10 in the Opioid Therapy Risk Report tool of the De11 partment— 

12 (A) information on the most recent time 

13 the tool was accessed by a health care provider 

14 of the Department with respect to each veteran; 

15 and 

16 (B) information on the results of the most 

17 recent urine drug test for each veteran. 

18 (2) CAPABILITIES.—The Secretary shall include 

19 in the Opioid Therapy Risk Report tool the ability 

20 of the health care providers of the Department to 

21 determine whether a health care provider of the De22 partment prescribed opioids to a veteran without 

23 checking the information in the tool with respect to 

24 the veteran. 
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1 (g) NOTIFICATIONS OF RISK IN COMPUTERIZED

2 HEALTH RECORD.—The Secretary shall modify the com3 puterized patient record system of the Department to en4 sure that any health care provider that accesses the record 

5 of a veteran, regardless of the reason the veteran seeks 

6 care from the health care provider, will be immediately no7 tified whether the veteran— 

8 (1) is receiving opioid therapy and has a history 

9 of substance use disorder or prior instances of over10 dose; 

11 (2) has a history of opioid abuse; or 

12 (3) is at risk of becoming an opioid abuser as 

13 determined by a health care provider who is treating 

14 the veteran. 

15 (h) DEFINITIONS.—In this section: 

16 (1) The term ‘‘controlled substance’’ has the 

17 meaning given that term in section 102 of the Con18 trolled Substances Act (21 U.S.C. 802). 

19 (2) The term ‘‘State’’ means each of the several 

20 States, territories, and possessions of the United 

21 States, the District of Columbia, and the Common22 wealth of Puerto Rico. 
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1 SEC. 3. STRENGTHENING OF JOINT WORKING GROUP ON 

2 PAIN MANAGEMENT OF THE DEPARTMENT 

3 OF VETERANS AFFAIRS AND THE DEPART4 MENT OF DEFENSE. 

5 (a) IN GENERAL.—Not later than 90 days after the 

6 date of enactment of this Act, the Secretary of Veterans 

7 Affairs and the Secretary of Defense shall ensure that the 

8 Pain Management Working Group of the Health Execu9 tive Committee of the Department of Veterans Affairs– 

10 Department of Defense Joint Executive Committee (Pain 

11 Management Working Group) established under section 

12 320 of title 38, United States Code, includes a focus on 

13 the following: 

14 (1) The opioid prescribing practices of health 

15 care providers of each Department. 

16 (2) The ability of each Department to manage 

17 acute and chronic pain among individuals receiving 

18 health care from the Department, including training 

19 health care providers with respect to pain manage20 ment. 

21 (3) The use by each Department of complemen22 tary and integrative health and complementary alter23 native medicines in treating such individuals. 

24 (4) The concurrent use by health care providers 

25 of each Department of opioids and prescription 
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1 drugs to treat mental health disorders, including 

2 benzodiazepines. 

3 (5) The practice by health care providers of 

4 each Department of prescribing opioids to treat 

5 mental health disorders. 

6 (6) The coordination in coverage of and con7 sistent access to medications prescribed for patients 

8 transitioning from receiving health care from the 

9 Department of Defense to receiving health care from 

10 the Department of Veterans Affairs. 

11 (7) The ability of each Department to identify 

12 and treat substance use disorders among individuals 

13 receiving health care from that Department. 

14 (b) COORDINATION AND CONSULTATION.—The Sec15 retary of Veterans Affairs and the Secretary of Defense 

16 shall ensure that the working group described in sub17 section (a)— 

18 (1) coordinates the activities of the working 

19 group with other relevant working groups estab20 lished under section 320 of title 38, United States 

21 Code; 

22 (2) consults with other relevant Federal agen23 cies with respect to the activities of the working 

24 group; and 
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1 (3) consults with the Department of Veterans 

2 Affairs and the Department of Defense with respect 

3 to, reviews, and comments on the VA/DOD Clinical 

4 Practice Guideline for Management of Opioid Ther5 apy for Chronic Pain, or any successor guideline, be6 fore any update to the guideline is released. 

7 (c) CLINICAL PRACTICE GUIDELINES.— 

8 (1) IN GENERAL.—Not later than 180 days 

9 after the date of the enactment of this Act, the Sec10 retary of Veterans Affairs and the Secretary of De11 fense shall issue an update to the VA/DOD Clinical 

12 Practice Guideline for Management of Opioid Ther13 apy for Chronic Pain. 

14 (2) MATTERS INCLUDED.—In conducting the 

15 update under subsection (a), the Pain Management 

16 Working Group, in coordination with the Clinical 

17 Practice Guideline VA/DOD Management of Opioid 

18 Therapy for Chronic Pain Working Group, shall ex19 amine whether the Clinical Practical Guideline 

20 should include the following: 

21 (A) Enhanced guidance with respect to— 

22 (i) the coadministration of an opioid 

23 and other drugs, including 

24 benzodiazepines, that may result in life25 limiting drug interactions; 
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1 (ii) the treatment of patients with 

2 current acute psychiatric instability or sub3 stance use disorder or patients at risk of 

4 suicide; and 

5 (iii) the use of opioid therapy to treat 

6 mental health disorders other than opioid 

7 use disorder. 

8 (B) Enhanced guidance with respect to the 

9 treatment of patients with behaviors or 

10 comorbidities, such as post-traumatic stress dis11 order or other psychiatric disorders, or a his12 tory of substance abuse or addiction, that re13 quires a consultation or comanagement of 

14 opioid therapy with one or more specialists in 

15 pain management, mental health, or addictions. 

16 (C) Enhanced guidance with respect to 

17 health care providers— 

18 (i) conducting an effective assessment 

19 for patients beginning or continuing opioid 

20 therapy, including understanding and set21 ting realistic goals with respect to achiev22 ing and maintaining an expected level of 

23 pain relief, improved function, or a clini24 cally appropriate combination of both; and 
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1 (ii) effectively assessing whether 

2 opioid therapy is achieving or maintaining 

3 the established treatment goals of the pa4 tient or whether the patient and health 

5 care provider should discuss adjusting, 

6 augmenting, or discontinuing the opioid 

7 therapy. 

8 (D) Guidelines to govern the methodologies 

9 used by health care providers of the Depart10 ment of Veterans Affairs and the Department 

11 of Defense to taper opioid therapy when adjust12 ing or discontinuing the use of opioid therapy. 

13 (E) Guidelines with respect to appropriate 

14 case management for patients receiving opioid 

15 therapy who transition between inpatient and 

16 outpatient health care settings, which may in17 clude the use of care transition plans. 

18 (F) Guidelines with respect to appropriate 

19 case management for patients receiving opioid 

20 therapy who transition from receiving care dur21 ing active duty to post-military health care net22 works. 

23 (G) Guidelines with respect to providing 

24 options, before initiating opioid therapy, for 

25 pain management therapies without the use of 
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1 opioids and options to augment opioid therapy 

2 with other clinical and complementary and inte3 grative health services to minimize opioid de4 pendence. 

5 (H) Guidelines with respect to the provi6 sion of evidence-based non-opioid treatments 

7 within the Department of Veterans Affairs and 

8 the Department of Defense, including medical 

9 devices and other therapies approved or cleared 

10 by the Food and Drug Administration for the 

11 treatment of chronic pain as an alternative to 

12 or to augment opioid therapy. 

13 SEC. 4. REVIEW, INVESTIGATION, AND REPORT ON USE OF 

14 OPIOIDS IN TREATMENT BY DEPARTMENT OF 

15 VETERANS AFFAIRS. 

16 (a) COMPTROLLER GENERAL REPORT.— 

17 (1) IN GENERAL.—Not later than 2 years after 

18 the date of the enactment of this Act, the Comp19 troller General of the United States shall submit to 

20 the Committee on Veterans’ Affairs of the Senate 

21 and the Committee on Veterans’ Affairs of the 

22 House of Representatives a report on the Opioid 

23 Safety Initiative of the Department of Veterans Af24 fairs and the opioid prescribing practices of health 

25 care providers of the Department. 
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1 (2) ELEMENTS.—The report submitted under 

2 paragraph (1) shall include the following: 

3 (A) Recommendations on such improve4 ments to the Opioid Safety Initiative of the De5 partment as the Comptroller General considers 

6 appropriate. 

7 (B) Information with respect to— 

8 (i) deaths resulting from sentinel 

9 events involving veterans prescribed opioids 

10 by a health care provider of the Depart11 ment; 

12 (ii) overall prescription rates and pre13 scriptions indications of opioids to treat 

14 non-cancer, non-palliative, and non-hospice 

15 care patients; 

16 (iii) the prescription rates and pre17 scriptions indications of benzodiazepines 

18 and opioids concomitantly by health care 

19 providers of the Department; 

20 (iv) the practice by health care pro21 viders of the Department of prescribing 

22 opioids to treat patients without any pain, 

23 including to treat patients with mental 

24 health disorders other than opioid use dis25 order; and 
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1 (v) the effectiveness of opioid therapy 

2 for patients receiving such therapy, includ3 ing the effectiveness of long-term opioid 

4 therapy. 

5 (C) An evaluation of processes of the De6 partment in place to oversee opioid use among 

7 veterans, including procedures to identify and 

8 remedy potential over-prescribing of opioids by 

9 health care providers of the Department. 

10 (D) An assessment of the implementation 

11 by the Secretary of the VA/DOD Clinical Prac12 tice Guideline for Management of Opioid Ther13 apy for Chronic Pain. 

14 (b) QUARTERLY PROGRESS REPORT ON IMPLEMEN15 TATION OF COMPTROLLER GENERAL RECOMMENDA16 TIONS.—Not later than 2 years after the date of the enact17 ment of this Act, and not later than 30 days after the 

18 end of each quarter thereafter, the Secretary of Veterans 

19 Affairs shall submit to the Committee on Veterans’ Affairs 

20 of the Senate and the Committee on Veterans’ Affairs of 

21 the House of Representatives a progress report detailing 

22 the actions by the Secretary during the period covered by 

23 the report to address any outstanding findings and rec24 ommendations by the Comptroller General of the United 
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1 States under subsection (a) with respect to the Veterans 

2 Health Administration. 

3 (c) ANNUAL REVIEW OF PRESCRIPTION RATES.— 

4 Not later than 1 year after the date of the enactment of 

5 this Act, and not less frequently than annually for the fol6 lowing 5 years, the Secretary shall submit to the Com7 mittee on Veterans’ Affairs of the Senate and the Com8 mittee on Veterans’ Affairs of the House of Representa9 tives a report, with respect to each medical facility of the 

10 Department of Veterans Affairs, to collect and review in11 formation on opioids prescribed by health care providers 

12 at the facility to treat non-cancer, non-palliative, and non13 hospice care patients that contains, for the 1-year period 

14 preceding the submission of the report, the following: 

15 (1) The number of patients and the percentage 

16 of the patient population of the Department who 

17 were prescribed benzodiazepines and opioids concur18 rently by a health care provider of the Department. 

19 (2) The number of patients and the percentage 

20 of the patient population of the Department without 

21 any pain who were prescribed opioids by a health 

22 care provider of the Department, including those 

23 who were prescribed benzodiazepines and opioids 

24 concurrently. 
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1 (3) The number of non-cancer, non-palliative, 

2 and non-hospice care patients and the percentage of 

3 such patients who were treated with opioids by a 

4 health care provider of the Department on an inpa5 tient-basis and who also received prescription opioids 

6 by mail from the Department while being treated on 

7 an inpatient-basis. 

8 (4) The number of non-cancer, non-palliative, 

9 and non-hospice care patients and the percentage of 

10 such patients who were prescribed opioids concur11 rently by a health care provider of the Department 

12 and a health care provider that is not health care 

13 provider of the Department. 

14 (5) With respect to each medical facility of the 

15 Department, information on opioids prescribed by 

16 health care providers at the facility to treat non-can17 cer, non-palliative, and non-hospice care patients, in18 cluding information on— 

19 (A) the prescription rate at which each 

20 health care provider at the facility prescribed 

21 benzodiazepines and opioids concurrently to 

22 such patients and the aggregate such prescrip23 tion rate for all health care providers at the fa24 cility; 
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1 (B) the prescription rate at which each 

2 health care provider at the facility prescribed 

3 benzodiazepines or opioids to such patients to 

4 treat conditions for which benzodiazepines or 

5 opioids are not approved treatment and the ag6 gregate such prescription rate for all health 

7 care providers at the facility; 

8 (C) the prescription rate at which each 

9 health care provider at the facility prescribed or 

10 dispensed mail-order prescriptions of opioids to 

11 such patients while such patients were being 

12 treated with opioids on an inpatient-basis and 

13 the aggregate of such prescription rate for all 

14 health care providers at the facility; and 

15 (D) the prescription rate at which each 

16 health care provider at the facility prescribed 

17 opioids to such patients who were also concur18 rently prescribed opioids by a health care pro19 vider that is not a health care provider of the 

20 Department and the aggregate of such prescrip21 tion rates for all health care providers at the fa22 cility. 

23 (6) With respect to each medical facility of the 

24 Department, the number of times a pharmacist at 

25 the facility overrode a critical drug interaction warn-
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1 ing with respect to an interaction between opioids 

2 and another medication before dispensing such medi3 cation to a veteran. 

4 (d) INVESTIGATION OF PRESCRIPTION RATES.—If 

5 the Secretary determines that a prescription rate with re6 spect to a health care provider or medical facility of the 

7 Department conflicts with or is otherwise inconsistent 

8 with the standards of appropriate and safe care, the Sec9 retary shall— 

10 (1) immediately notify the Committee on Vet11 erans’ Affairs of the Senate and the Committee on 

12 Veterans’ Affairs of the House of Representatives of 

13 such determination, including information relating to 

14 such determination, prescription rate, and health 

15 care provider or medical facility, as the case may be; 

16 and 

17 (2) through the Office of the Medical Inspector 

18 of the Veterans Health Administration, conduct a 

19 full investigation of the health care provider or med20 ical facility, as the case may be. 

21 (e) PRESCRIPTION RATE DEFINED.—In this section, 

22 the term ‘‘prescription rate’’ means, with respect to a 

23 health care provider or medical facility of the Department, 

24 each of the following: 
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1 (1) The number of patients treated with opioids 

2 by the health care provider or at the medical facility, 

3 as the case may be, divided by the total number of 

4 pharmacy users of that health care provider or med5 ical facility. 

6 (2) The average number of morphine equiva7 lents per day prescribed by the health care provider 

8 or at the medical facility, as the case may be, to pa9 tients being treated with opioids. 

10 (3) Of the patients being treated with opioids 

11 by the health care provider or at the medical facility, 

12 as the case may be, the average number of prescrip13 tions of opioids per patient. 

14 SEC. 5. MANDATORY DISCLOSURE OF CERTAIN VETERAN 

15 INFORMATION TO STATE CONTROLLED SUB16 STANCE MONITORING PROGRAMS. 

17 Section 5701(l) of title 38, United States Code, is 

18 amended by striking ‘‘may’’ and inserting ‘‘shall’’. 

19 SEC. 6. MODIFICATION TO LIMITATION ON AWARDS AND 

20 BONUSES. 

21 Section 705 of the Veterans Access, Choice, and Ac22 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

23 703 note) is amended to read as follows: 
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1 ‘‘SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO 

2 EMPLOYEES OF DEPARTMENT OF VETERANS 

3 AFFAIRS. 

4 ‘‘The Secretary of Veterans Affairs shall ensure that 

5 the aggregate amount of awards and bonuses paid by the 

6 Secretary in a fiscal year under chapter 45 or 53 of title 

7 5, United States Code, or any other awards or bonuses 

8 authorized under such title or title 38, United States 

9 Code, does not exceed the following amounts: 

10 ‘‘(1) With respect to each of fiscal years 2017 

11 through 2021, $230,000,000. 

12 ‘‘(2) With respect to each of fiscal years 2022 

13 through 2024, $360,000,000.’’. 

Passed the House of Representatives May 10, 2016. 

Attest: 

Clerk. 
114TH CONGRESS 

2D SESSION H. R. 4063 

AN ACT 

To improve the use by the Secretary of Veterans 

other purposes. Affairs of opioids in treating veterans, and for