IB 
Union Calendar No. 422 
114TH CONGRESS 
2D SESSION 
H. R. 4063 
[Report No. 114–546, Part I] 
To improve the use by the Secretary of Veterans Affairs of opioids in treating 
veterans, to improve patient advocacy by the Secretary, and to expand 
the availability of complementary and integrative health, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 18, 2015 
Mr. BILIRAKIS (for himself, Mr. KIND, Miss RICE of New York, Mrs. 
WALORSKI, Mr. MCKINLEY, Mr. BOST, Mr. COFFMAN, Mr. ROSS, Mr. 
RYAN of Ohio, Mrs. RADEWAGEN, Mr. CRAWFORD, Mr. MICA, Ms. 
FRANKEL of Florida, Ms. KUSTER, Mr. MCCAUL, and Mr. WALZ) intro-
duced the following bill; which was referred to the Committee on Vet-
erans’ Affairs, and in addition to the Committee on Armed Services, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
MAY 10, 2016 
Additional sponsors: Mr. POCAN, Mr. RIBBLE, Mr. SENSENBRENNER, Mr. 
ASHFORD, Mr. CARNEY, Mr. JONES, Ms. DUCKWORTH, Ms. MCSALLY, 
Mrs. BLACK, Mr. YOUNG of Iowa, Ms. LOFGREN, Mrs. NAPOLITANO, Mr. 
BUCSHON, Mr. BLUMENAUER, Mrs. HARTZLER, Mr. MOULTON, Mr. 
GUINTA, Mr. KILMER, Mr. CICILLINE, and Mr. TIPTON 
MAY 10, 2016 
Reported from the Committee on Veterans’ Affairs with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
MAY 10, 2016 
The Committee on Armed Services discharged; committed to the Committee 
of the Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on November 18, 2015] 
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A BILL 
To improve the use by the Secretary of Veterans Affairs 
of opioids in treating veterans, to improve patient advo-
cacy by the Secretary, and to expand the availability 
of complementary and integrative health, and for other 
purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Pro-
moting Responsible Opioid Management and Incorporating 
Scientific Expertise Act’’ or the ‘‘Jason Simcakoski PROM-
ISE Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—OPIOID THERAPY AND PAIN MANAGEMENT 
Sec. 101. Establishment of Advisory Committee to review guidelines on manage-
ment of opioid therapy by Department of Veterans Affairs and 
Department of Defense. 
Sec. 102. Improvement of opioid safety measures by Department of Veterans Af-
fairs. 
Sec. 103. Strengthening of joint working group on pain management of the De-
partment of Veterans Affairs and the Department of Defense. 
Sec. 104. Review, investigation, and report on use of opioids in treatment by De-
partment of Veterans Affairs. 
Sec. 105. Mandatory disclosure of certain veteran information to State controlled 
substance monitoring programs. 
TITLE II—PATIENT ADVOCACY 
Sec. 201. Community meetings on improving care furnished by Department of 
Veterans Affairs. 
Sec. 202. Improvement of awareness of patient advocacy program and patient bill 
of rights of Department of Veterans Affairs. 
Sec. 203. Comptroller general report on patient advocacy program of Department 
of Veterans Affairs. 
TITLE III—COMPLEMENTARY AND INTEGRATIVE HEALTH 
Sec. 301. Expansion of research and education on and delivery of complementary 
and integrative health to veterans. 
Sec. 302. Pilot program on integration of complementary alternative medicines 
and related issues for veterans and family members of veterans. 
TITLE IV—FITNESS OF HEALTH CARE PROVIDERS 
Sec. 401. Additional requirements for hiring of health care providers by Depart-
ment of Veterans Affairs. 
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Sec. 402. Provision of information on health care providers of Department of Vet-
erans Affairs to State Medical Boards. 
Sec. 403. Report on compliance by Department of Veterans Affairs with reviews 
of health care providers leaving the Department or transferring 
to other facilities. 
TITLE V—OTHER VETERANS MATTERS 
Sec. 501. Audit of Veterans Health Administration programs of Department of 
Veterans Affairs. 
TITLE I—OPIOID THERAPY AND 
PAIN MANAGEMENT 
SEC. 101. ESTABLISHMENT OF ADVISORY COMMITTEE TO 
REVIEW GUIDELINES ON MANAGEMENT OF 
OPIOID THERAPY BY DEPARTMENT OF VET-
ERANS AFFAIRS AND DEPARTMENT OF DE-
FENSE. 
(a) ADVISORY COMMITTEE.—Not later than 120 days 
after the date of the enactment of this Act, the Secretary 
of Veterans Affairs and the Secretary of Defense shall joint-
ly convene an advisory committee to— 
(1) conduct a thorough review of the most recent 
VA/DOD Clinical Practice Guideline for Management 
of Opioid Therapy for Chronic Pain; and 
(2) make recommendations to the Secretaries 
with respect to updating the Clinical Practice Guide-
line. 
(b) MATTERS INCLUDED.—In conducting the review 
under subsection (a)(1), the Advisory Committee shall ex-
amine whether the Clinical Practical Guideline should in-
clude the following: 
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(1) Enhanced guidance with respect to— 
(A) the coadministration of an opioid and 
other drugs, including benzodiazepines, that may 
result in life-limiting drug interactions; 
(B) the treatment of patients with current 
acute psychiatric instability or substance use 
disorder or patients at risk of suicide; and 
(C) the use of opioid therapy to treat men-
tal health disorders other than opioid use dis-
order. 
(2) Enhanced guidance with respect to the treat-
ment of patients with behaviors or comorbidities, such 
as post-traumatic stress disorder or other psychiatric 
disorders, or a history of substance abuse or addic-
tion, that requires a consultation or comanagement of 
opioid therapy with one or more specialists in pain 
management, mental health, or addictions. 
(3) Enhanced guidance with respect to health 
care providers— 
(A) conducting an effective assessment for 
patients beginning or continuing opioid therapy, 
including understanding and setting realistic 
goals with respect to achieving and maintaining 
an expected level of pain relief, improved func-
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tion, or a clinically appropriate combination of 
both; and 
(B) effectively assessing whether opioid ther-
apy is achieving or maintaining the established 
treatment goals of the patient or whether the pa-
tient and health care provider should discuss ad-
justing, augmenting , or discontinuing the opioid 
therapy. 
(4) Guidance that each health care provider of 
the Department of Veterans Affairs and the Depart-
ment of Defense, before initiating opioid therapy to 
treat a patient as part of the comprehensive assess-
ment conducted by the health care provider, use the 
Opioid Therapy Risk Report tool of the Department 
of Veterans Affairs (or similar monitoring tool), 
which shall include information from the prescription 
drug monitoring program of each State that includes 
the most recent information to date relating to the 
patient that accessed such program to assess the risk 
for adverse outcomes of opioid therapy for the patient, 
including the concurrent use of controlled substances 
such as benzodiazepines, as part of the comprehensive 
assessment conducted by the health care provider. 
(5) Guidelines to govern the methodologies used 
by health care providers of the Department of Vet-
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erans Affairs and the Department of Defense to taper 
opioid therapy when adjusting or discontinuing the 
use of opioid therapy. 
(6) Guidelines with respect to appropriate case 
management for patients receiving opioid therapy 
who transition between inpatient and outpatient 
health care settings, which may include the use of 
care transition plans. 
(7) Guidelines with respect to appropriate case 
management for patients receiving opioid therapy 
who transition from receiving care during active duty 
to post-military health care networks. 
(8) Enhanced standards with respect to the use 
of routine and random urine drug tests for all pa-
tients before and during opioid therapy to help pre-
vent substance abuse, dependence, and diversion, in-
cluding— 
(A) that such tests occur not less frequently 
than once each year; and 
(B) that health care providers appropriately 
order, interpret and respond to the results from 
such tests to tailor pain therapy, safeguards, and 
risk management strategies to each patient. 
(9) Guidance that health care providers discuss 
with patients, before initiating opioid therapy, op-
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tions for pain management therapies without the use 
of opioids and options to augment opioid therapy 
with other clinical and complementary and integra-
tive health services to minimize opioid dependence. 
(10) Guidance for health care providers with re-
spect to evidence-based non-opioid treatments within 
the Department of Veterans Affairs and the Depart-
ment of Defense, including medical devices and other 
therapies approved or cleared by the Food and Drug 
Administration for the treatment of chronic pain as 
an alternative to or to augment opioid therapy. 
(c) CONSULTATION.—In carrying out the review under 
paragraph (1) of subsection (a), and before making the rec-
ommendations under paragraph (2) of such subsection, the 
Advisory Committee shall consult with the VA/DOD Man-
agement of Opioid Therapy for Chronic Pain Working 
Group. 
(d) SUBMISSION.—Not later than one year after the 
date of the enactment of this Act, the Advisory Committee 
shall submit to the Secretaries the review and recommenda-
tions described in subsection (a)(1). 
(e) APPLICATION OF FEDERAL ADVISORY COMMITTEE 
ACT.—The provisions of the Federal Advisory Committee 
Act (5 U.S.C. App.) shall apply to the Advisory Committee. 
(f) DEFINITIONS.—In this section: 
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(1) The term ‘‘Advisory Committee’’ means the 
advisory committee established under subsection (a). 
(2) The term ‘‘Clinical Practice Guideline’’ 
means the VA/DOD Clinical Practice Guideline for 
Management of Opioid Therapy for Chronic Pain. 
(3) The term ‘‘controlled substance’’ has the 
meaning given that term in section 102 of the Con-
trolled Substances Act (21 U.S.C. 802). 
(4) The term ‘‘State’’ means each of the several 
States, territories, and possessions of the United 
States, the District of Columbia, and the Common-
wealth of Puerto Rico. 
SEC. 102. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) 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 Af-
fairs to include all medical facilities of the Department. 
(b) PAIN MANAGEMENT EDUCATION AND TRAINING.— 
(1) IN GENERAL.—In carrying out the Opioid 
Safety Initiative of the Department, the Secretary 
shall require all employees of the Department respon-
sible for prescribing opioids to receive education and 
training described in paragraph (2). 
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(2) EDUCATION AND TRAINING.—Education and 
training described in this paragraph is education and 
training on pain management and safe opioid pre-
scribing practices for purposes of safely and effectively 
managing patients with chronic pain, including edu-
cation and training on the following: 
(A) The implementation of and full compli-
ance with the VA/DOD Clinical Practice Guide-
line for Management of Opioid Therapy for 
Chronic Pain, including any update to such 
guideline. 
(B) The use of evidence-based pain manage-
ment therapies, including cognitive-behavioral 
therapy, non-opioid alternatives, and non-drug 
methods and procedures to managing pain and 
related health conditions including medical de-
vices approved or cleared by the Food and Drug 
Administration for the treatment of patients 
with chronic pain and complementary alter-
native medicines. 
(C) Screening and identification of patients 
with substance use disorder, including drug-seek-
ing behavior, before prescribing opioids, assess-
ment of risk potential for patients developing an 
addiction, and referral of patients to appropriate 
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addiction treatment professionals if addiction is 
identified or strongly suspected. 
(D) 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 relat-
ing to the use of opioids and other controlled 
substances. 
(E) 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. 
(3) 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). 
(c) PAIN MANAGEMENT TEAMS.— 
(1) 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 fa-
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cility for patients experiencing acute and chronic 
pain that is non-cancer related. 
(2) ESTABLISHMENT OF PROTOCOLS.— 
(A) IN GENERAL.—In consultation with the 
Directors of each Veterans Integrated Service 
Network, the Secretary shall establish standard 
protocols for the designation of pain manage-
ment teams at each medical facility within the 
Department. 
(B) CONSULTATION
ON
PRESCRIPTION
OF 
OPIOIDS.—Each protocol established under sub-
paragraph (A) shall ensure that any health care 
provider without expertise in prescribing analge-
sics or who has not completed the education and 
training under subsection (b), including a men-
tal health care provider, does not prescribe 
opioids to a patient unless that health care pro-
vider— 
(i) consults with a health care provider 
with pain management expertise or who is 
on the pain management team of the med-
ical facility; and 
(ii) refers the patient to the pain man-
agement team for any subsequent prescrip-
tions and related therapy. 
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(3) REPORT.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the direc-
tor of each medical facility of the Department 
shall submit to the Under Secretary for Health 
and the director of the Veterans Integrated Serv-
ice Network in which the medical facility is lo-
cated a report identifying the health care profes-
sionals that have been designated as members of 
the pain management team at the medical facil-
ity pursuant to paragraph (1). 
(B) ELEMENTS.—Each report submitted 
under subparagraph (A) with respect to a med-
ical facility of the Department shall include— 
(i) a certification as to whether all 
members of the pain management team at 
the medical facility have completed the edu-
cation and training required under sub-
section (b); 
(ii) a plan for the management and re-
ferral of patients to such pain management 
team if health care providers without exper-
tise in prescribing analgesics prescribe 
opioid medications to treat acute and 
chronic pain that is non-cancer related; and 
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(iii) a certification as to whether the 
medical facility— 
(I) 
fully 
complies 
with 
the 
stepped-care model of pain manage-
ment and other pain management poli-
cies contained in Directive 2009-053 of 
the Veterans Health Administration, or 
successor directive; or 
(II) does not fully comply with 
such stepped-care model of pain man-
agement and other pain management 
policies but is carrying out a corrective 
plan of action to ensure such full com-
pliance. 
(d) TRACKING AND MONITORING OF OPIOID USE.— 
(1) PRESCRIPTION DRUG MONITORING PROGRAMS 
OF STATES.—In carrying out the Opioid Safety Ini-
tiative and the Opioid Therapy Risk Report tool of 
the Department, the Secretary shall— 
(A) ensure access by health care providers of 
the Department to information on controlled sub-
stances, 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 
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