IIB 
114TH CONGRESS 
2D SESSION 
H. R. 4063 
IN THE SENATE OF THE UNITED STATES 
MAY 11, 2016 
Received; read twice and referred to the Committee on Veterans’ Affairs 
AN ACT 
To improve the use by the Secretary of Veterans Affairs 
of opioids in treating veterans, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Promoting Responsible 
Opioid Management and Incorporating Scientific Exper-
tise Act’’ or the ‘‘Jason Simcakoski PROMISE Act’’. 
SEC. 2. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) EXPANSION OF OPIOID SAFETY INITIATIVE.— 
(1) INCLUSION OF ALL MEDICAL FACILITIES.— 
Not later than 180 days after the date of the enact-
ment of this Act, the Secretary of Veterans Affairs 
shall expand the Opioid Safety Initiative of the De-
partment of Veterans Affairs to include all medical 
facilities of the Department. 
(2) GUIDANCE.—The Secretary shall establish 
guidance that each health care provider of the De-
partment of Veterans Affairs, before initiating opioid 
therapy to treat a patient as part of the comprehen-
sive assessment conducted by the health care pro-
vider, use the Opioid Therapy Risk Report tool of 
the Department of Veterans Affairs (or any subse-
quent tool), which shall include information from the 
prescription drug monitoring program of each par-
ticipating State as applicable, 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, 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
including the concurrent use of controlled substances 
such as benzodiazepines, as part of the comprehen-
sive assessment conducted by the health care pro-
vider. 
(3) ENHANCED
STANDARDS.—The Secretary 
shall establish enhanced standards with respect to 
the use of routine and random urine drug tests for 
all patients before and during opioid therapy to help 
prevent substance abuse, dependence, and diversion, 
including— 
(A) that such tests occur not less fre-
quently than once each year; and 
(B) that health care providers appro-
priately order, interpret and respond to the re-
sults from such tests to tailor pain therapy, 
safeguards, and risk management strategies to 
each patient. 
(b) PAIN MANAGEMENT EDUCATION
AND TRAIN-
ING.— 
(1) IN GENERAL.—In carrying out the Opioid 
Safety Initiative of the Department, the Secretary 
shall require all employees of the Department re-
sponsible for prescribing opioids to receive education 
and training described in paragraph (2). 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(2) EDUCATION
AND
TRAINING.—Education 
and training described in this paragraph is edu-
cation and training on pain management and safe 
opioid prescribing practices for purposes of safely 
and effectively managing patients with chronic pain, 
including education and training on the following: 
(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 man-
agement therapies, including cognitive-behav-
ioral therapy, non-opioid alternatives, and non- 
drug methods and procedures to managing pain 
and related health conditions including medical 
devices approved or cleared by the Food and 
Drug Administration for the treatment of pa-
tients with chronic pain and complementary al-
ternative medicines. 
(C) Screening and identification of patients 
with substance use disorder, including drug- 
seeking behavior, before prescribing opioids, as-
sessment of risk potential for patients devel-
oping an addiction, and referral of patients to 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
appropriate 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, includ-
ing the need to safely store and dispose of sup-
plies relating 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 iden-
tify and designate a pain management team of 
health care professionals, which may include board 
certified pain medicine specialists, responsible for co-
ordinating and overseeing pain management therapy 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
at such facility 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 Serv-
ice Network, the Secretary shall establish 
standard protocols for the designation of pain 
management 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 anal-
gesics or who has not completed the education 
and training under subsection (b), including a 
mental health care provider, does not prescribe 
opioids to a patient unless that health care pro-
vider— 
(i) consults with a health care pro-
vider with pain management expertise or 
who is on the pain management team of 
the medical facility; and 
(ii) refers the patient to the pain man-
agement team for any subsequent prescrip-
tions and related therapy. 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(3) REPORT.— 
(A) IN GENERAL.—Not later than 1 year 
after the date of enactment of this Act, the di-
rector of each medical facility of the Depart-
ment shall submit to the Under Secretary for 
Health and the director of the Veterans Inte-
grated Service Network in which the medical fa-
cility is located a report identifying the health 
care professionals that have been designated as 
members of the pain management team at the 
medical facility pursuant to paragraph (1). 
(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 
education and training required under sub-
section (b); 
(ii) a plan for the management and 
referral of patients to such pain manage-
ment team if health care providers without 
expertise in prescribing analgesics pre-
scribe opioid medications to treat acute 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
and chronic pain that is non-cancer re-
lated; and 
(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 
policies contained in Directive 2009– 
053 of the Veterans Health Adminis-
tration, 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 correc-
tive plan of action to ensure such full 
compliance. 
(d) TRACKING AND MONITORING OF OPIOID USE.— 
(1) PRESCRIPTION
DRUG
MONITORING
PRO-
GRAMS
OF
STATES.—In carrying out the Opioid 
Safety Initiative and the Opioid Therapy Risk Re-
port tool of the Department, the Secretary shall— 
(A) ensure access by health care providers 
of the Department to information on controlled 
substances, 
including 
opioids 
and 
benzodiazepines, prescribed to veterans who re-
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
ceive care outside the Department through the 
prescription drug monitoring program of each 
State with such a program, including by seek-
ing to enter into memoranda of understanding 
with States to allow shared access of such infor-
mation between States and the Department; 
(B) include such information in the Opioid 
Therapy Risk Report; and 
(C) require health care providers of the 
Department to submit to the prescription drug 
monitoring program of each State information 
on prescriptions of controlled substances re-
ceived by veterans in that State under the laws 
administered by the Secretary. 
(2) REPORT ON TRACKING OF DATA ON OPIOID 
USE.—Not later than 18 months after the date of 
the enactment of this Act, the Secretary shall submit 
to the Committee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of the 
House of Representatives a report on the feasibility 
and advisability of improving the Opioid Therapy 
Risk Report tool of the Department to allow for 
more advanced real-time tracking of and access to 
data on— 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(A) the key clinical indicators with respect 
to the totality of opioid use by veterans; 
(B) concurrent prescribing by health care 
providers of the Department of opioids in dif-
ferent health care settings, including data on 
concurrent prescribing of opioids to treat men-
tal health disorders other than opioid use dis-
order; and 
(C) mail-order prescriptions of opioid pre-
scribed to veterans under the laws administered 
by the Secretary. 
(e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO-
NISTS.— 
(1) INCREASED AVAILABILITY AND USE.— 
(A) IN
GENERAL.—The Secretary shall 
maximize the availability of opioid receptor an-
tagonists approved by the Food and Drug Ad-
ministration, including naloxone, to veterans. 
(B) AVAILABILITY, TRAINING, AND
DIS-
TRIBUTING.—In carrying out subparagraph 
(A), not later than 90 days after the date of the 
enactment of this Act, the Secretary shall— 
(i) equip each pharmacy of the De-
partment with opioid receptor antagonists 
approved by the Food and Drug Adminis-
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
tration to be dispensed to outpatients as 
needed; and 
(ii) expand the Overdose Education 
and Naloxone Distribution program of the 
Department to ensure that all veterans in 
receipt of health care under laws adminis-
tered by the Secretary who are at risk of 
opioid overdose may access such opioid re-
ceptor antagonists and training on the 
proper administration of such opioid recep-
tor antagonists. 
(C) VETERANS WHO ARE AT RISK.—For 
purposes of subparagraph (B), veterans who are 
at risk of opioid overdose include— 
(i) veterans receiving long-term opioid 
therapy; 
(ii) veterans receiving opioid therapy 
who have a history of substance use dis-
order or prior instances of overdose; and 
(iii) veterans who are at risk as deter-
mined by a health care provider who is 
treating the veteran. 
(2) REPORT.—Not later than 120 days after 
the date of the enactment of this Act, the Secretary 
shall submit to the Committee on Veterans’ Affairs 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report on 
carrying out paragraph (1), including an assessment 
of any remaining steps to be carried out by the Sec-
retary to carry out such paragraph. 
(f) INCLUSION OF CERTAIN INFORMATION AND CA-
PABILITIES IN OPIOID THERAPY RISK REPORT TOOL OF 
THE DEPARTMENT.— 
(1) INFORMATION.—The Secretary shall include 
in the Opioid Therapy Risk Report tool of the De-
partment— 
(A) information on the most recent time 
the tool was accessed by a health care provider 
of the Department with respect to each veteran; 
and 
(B) information on the results of the most 
recent urine drug test for each veteran. 
(2) CAPABILITIES.—The Secretary shall include 
in the Opioid Therapy Risk Report tool the ability 
of the health care providers of the Department to 
determine whether a health care provider of the De-
partment prescribed opioids to a veteran without 
checking the information in the tool with respect to 
the veteran. 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(g) NOTIFICATIONS
OF RISK
IN COMPUTERIZED 
HEALTH RECORD.—The Secretary shall modify the com-
puterized patient record system of the Department to en-
sure that any health care provider that accesses the record 
of a veteran, regardless of the reason the veteran seeks 
care from the health care provider, will be immediately no-
tified whether the veteran— 
(1) is receiving opioid therapy and has a history 
of substance use disorder or prior instances of over-
dose; 
(2) has a history of opioid abuse; or 
(3) is at risk of becoming an opioid abuser as 
determined by a health care provider who is treating 
the veteran. 
(h) DEFINITIONS.—In this section: 
(1) The term ‘‘controlled substance’’ has the 
meaning given that term in section 102 of the Con-
trolled Substances Act (21 U.S.C. 802). 
(2) 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. 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
SEC. 3. STRENGTHENING OF JOINT WORKING GROUP ON 
PAIN MANAGEMENT OF THE DEPARTMENT 
OF VETERANS AFFAIRS AND THE DEPART-
MENT OF DEFENSE. 
(a) IN GENERAL.—Not later than 90 days after the 
date of enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense shall ensure that the 
Pain Management Working Group of the Health Execu-
tive Committee of the Department of Veterans Affairs– 
Department of Defense Joint Executive Committee (Pain 
Management Working Group) established under section 
320 of title 38, United States Code, includes a focus on 
the following: 
(1) The opioid prescribing practices of health 
care providers of each Department. 
(2) The ability of each Department to manage 
acute and chronic pain among individuals receiving 
health care from the Department, including training 
health care providers with respect to pain manage-
ment. 
(3) The use by each Department of complemen-
tary and integrative health and complementary alter-
native medicines in treating such individuals. 
(4) The concurrent use by health care providers 
of each Department of opioids and prescription 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
drugs to treat mental health disorders, including 
benzodiazepines. 
(5) The practice by health care providers of 
each Department of prescribing opioids to treat 
mental health disorders. 
(6) The coordination in coverage of and con-
sistent access to medications prescribed for patients 
transitioning from receiving health care from the 
Department of Defense to receiving health care from 
the Department of Veterans Affairs. 
(7) The ability of each Department to identify 
and treat substance use disorders among individuals 
receiving health care from that Department. 
(b) COORDINATION AND CONSULTATION.—The Sec-
retary of Veterans Affairs and the Secretary of Defense 
shall ensure that the working group described in sub-
section (a)— 
(1) coordinates the activities of the working 
group with other relevant working groups estab-
lished under section 320 of title 38, United States 
Code; 
(2) consults with other relevant Federal agen-
cies with respect to the activities of the working 
group; and 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(3) consults with the Department of Veterans 
Affairs and the Department of Defense with respect 
to, reviews, and comments on the VA/DOD Clinical 
Practice Guideline for Management of Opioid Ther-
apy for Chronic Pain, or any successor guideline, be-
fore any update to the guideline is released. 
(c) CLINICAL PRACTICE GUIDELINES.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs and the Secretary of De-
fense shall issue an update to the VA/DOD Clinical 
Practice Guideline for Management of Opioid Ther-
apy for Chronic Pain. 
(2) MATTERS
INCLUDED.—In conducting the 
update under subsection (a), the Pain Management 
Working Group, in coordination with the Clinical 
Practice Guideline VA/DOD Management of Opioid 
Therapy for Chronic Pain Working Group, shall ex-
amine whether the Clinical Practical Guideline 
should include the following: 
(A) Enhanced guidance with respect to— 
(i) the coadministration of an opioid 
and 
other 
drugs, 
including 
benzodiazepines, that may result in life- 
limiting drug interactions; 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(ii) the treatment of patients with 
current acute psychiatric instability or sub-
stance use disorder or patients at risk of 
suicide; and 
(iii) the use of opioid therapy to treat 
mental health disorders other than opioid 
use disorder. 
(B) Enhanced guidance with respect to the 
treatment 
of 
patients 
with 
behaviors 
or 
comorbidities, such as post-traumatic stress dis-
order or other psychiatric disorders, or a his-
tory of substance abuse or addiction, that re-
quires a consultation or comanagement of 
opioid therapy with one or more specialists in 
pain management, mental health, or addictions. 
(C) Enhanced guidance with respect to 
health care providers— 
(i) conducting an effective assessment 
for patients beginning or continuing opioid 
therapy, including understanding and set-
ting realistic goals with respect to achiev-
ing and maintaining an expected level of 
pain relief, improved function, or a clini-
cally appropriate combination of both; and 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(ii) 
effectively 
assessing 
whether 
opioid therapy is achieving or maintaining 
the established treatment goals of the pa-
tient or whether the patient and health 
care provider should discuss adjusting, 
augmenting, or discontinuing the opioid 
therapy. 
(D) Guidelines to govern the methodologies 
used by health care providers of the Depart-
ment of Veterans Affairs and the Department 
of Defense to taper opioid therapy when adjust-
ing or discontinuing the use of opioid therapy. 
(E) Guidelines with respect to appropriate 
case management for patients receiving opioid 
therapy who transition between inpatient and 
outpatient health care settings, which may in-
clude the use of care transition plans. 
(F) Guidelines with respect to appropriate 
case management for patients receiving opioid 
therapy who transition from receiving care dur-
ing active duty to post-military health care net-
works. 
(G) Guidelines with respect to providing 
options, before initiating opioid therapy, for 
pain management therapies without the use of 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
opioids and options to augment opioid therapy 
with other clinical and complementary and inte-
grative health services to minimize opioid de-
pendence. 
(H) Guidelines with respect to the provi-
sion of evidence-based non-opioid treatments 
within the Department of Veterans Affairs and 
the Department 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. 
SEC. 4. REVIEW, INVESTIGATION, AND REPORT ON USE OF 
OPIOIDS IN TREATMENT BY DEPARTMENT OF 
VETERANS AFFAIRS. 
(a) COMPTROLLER GENERAL REPORT.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of the enactment of this Act, the Comp-
troller General of the United States shall submit to 
the Committee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of the 
House of Representatives a report on the Opioid 
Safety Initiative of the Department of Veterans Af-
fairs and the opioid prescribing practices of health 
care providers of the Department. 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(2) ELEMENTS.—The report submitted under 
paragraph (1) shall include the following: 
(A) Recommendations on such improve-
ments to the Opioid Safety Initiative of the De-
partment as the Comptroller General considers 
appropriate. 
(B) Information with respect to— 
(i) deaths resulting from sentinel 
events involving veterans prescribed opioids 
by a health care provider of the Depart-
ment; 
(ii) overall prescription rates and pre-
scriptions indications of opioids to treat 
non-cancer, non-palliative, and non-hospice 
care patients; 
(iii) the prescription rates and pre-
scriptions indications of benzodiazepines 
and opioids concomitantly by health care 
providers of the Department; 
(iv) the practice by health care pro-
viders of the Department of prescribing 
opioids to treat patients without any pain, 
including to treat patients with mental 
health disorders other than opioid use dis-
order; and 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(v) the effectiveness of opioid therapy 
for patients receiving such therapy, includ-
ing the effectiveness of long-term opioid 
therapy. 
(C) An evaluation of processes of the De-
partment in place to oversee opioid use among 
veterans, including procedures to identify and 
remedy potential over-prescribing of opioids by 
health care providers of the Department. 
(D) An assessment of the implementation 
by the Secretary of the VA/DOD Clinical Prac-
tice Guideline for Management of Opioid Ther-
apy for Chronic Pain. 
(b) QUARTERLY PROGRESS REPORT ON IMPLEMEN-
TATION
OF
COMPTROLLER
GENERAL
RECOMMENDA-
TIONS.—Not later than 2 years after the date of the enact-
ment of this Act, and not later than 30 days after the 
end of each quarter thereafter, the Secretary of Veterans 
Affairs shall submit to the Committee on Veterans’ Affairs 
of the Senate and the Committee on Veterans’ Affairs of 
the House of Representatives a progress report detailing 
the actions by the Secretary during the period covered by 
the report to address any outstanding findings and rec-
ommendations by the Comptroller General of the United 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
States under subsection (a) with respect to the Veterans 
Health Administration. 
(c) ANNUAL REVIEW OF PRESCRIPTION RATES.— 
Not later than 1 year after the date of the enactment of 
this Act, and not less frequently than annually for the fol-
lowing 5 years, the Secretary shall submit to the Com-
mittee on Veterans’ Affairs of the Senate and the Com-
mittee on Veterans’ Affairs of the House of Representa-
tives a report, with respect to each medical facility of the 
Department of Veterans Affairs, to collect and review in-
formation on opioids prescribed by health care providers 
at the facility to treat non-cancer, non-palliative, and non- 
hospice care patients that contains, for the 1-year period 
preceding the submission of the report, the following: 
(1) The number of patients and the percentage 
of the patient population of the Department who 
were prescribed benzodiazepines and opioids concur-
rently by a health care provider of the Department. 
(2) The number of patients and the percentage 
of the patient population of the Department without 
any pain who were prescribed opioids by a health 
care provider of the Department, including those 
who were prescribed benzodiazepines and opioids 
concurrently. 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
ing with respect to an interaction between opioids 
and another medication before dispensing such medi-
cation to a veteran. 
(d) INVESTIGATION OF PRESCRIPTION RATES.—If 
the Secretary determines that a prescription rate with re-
spect to a health care provider or medical facility of the 
Department conflicts with or is otherwise inconsistent 
with the standards of appropriate and safe care, the Sec-
retary shall— 
(1) immediately notify the Committee on Vet-
erans’ Affairs of the Senate and the Committee on 
Veterans’ Affairs of the House of Representatives of 
such determination, including information relating to 
such determination, prescription rate, and health 
care provider or medical facility, as the case may be; 
and 
(2) through the Office of the Medical Inspector 
of the Veterans Health Administration, conduct a 
full investigation of the health care provider or med-
ical facility, as the case may be. 
(e) PRESCRIPTION RATE DEFINED.—In this section, 
the term ‘‘prescription rate’’ means, with respect to a 
health care provider or medical facility of the Department, 
each of the following: 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
(1) The number of patients treated with opioids 
by the health care provider or at the medical facility, 
as the case may be, divided by the total number of 
pharmacy users of that health care provider or med-
ical facility. 
(2) The average number of morphine equiva-
lents per day prescribed by the health care provider 
or at the medical facility, as the case may be, to pa-
tients being treated with opioids. 
(3) Of the patients being treated with opioids 
by the health care provider or at the medical facility, 
as the case may be, the average number of prescrip-
tions of opioids per patient. 
SEC. 5. MANDATORY DISCLOSURE OF CERTAIN VETERAN 
INFORMATION TO STATE CONTROLLED SUB-
STANCE MONITORING PROGRAMS. 
Section 5701(l) of title 38, United States Code, is 
amended by striking ‘‘may’’ and inserting ‘‘shall’’. 
SEC. 6. MODIFICATION TO LIMITATION ON AWARDS AND 
BONUSES. 
Section 705 of the Veterans Access, Choice, and Ac-
countability Act of 2014 (Public Law 113–146; 38 U.S.C. 
703 note) is amended to read as follows: 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS
HR 4063 RFS
‘‘SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO 
EMPLOYEES OF DEPARTMENT OF VETERANS 
AFFAIRS. 
‘‘The Secretary of Veterans Affairs shall ensure that 
the aggregate amount of awards and bonuses paid by the 
Secretary in a fiscal year under chapter 45 or 53 of title 
5, United States Code, or any other awards or bonuses 
authorized under such title or title 38, United States 
Code, does not exceed the following amounts: 
‘‘(1) With respect to each of fiscal years 2017 
through 2021, $230,000,000. 
‘‘(2) With respect to each of fiscal years 2022 
through 2024, $360,000,000.’’. 
Passed the House of Representatives May 10, 2016. 
Attest: 
KAREN L. HAAS, 
Clerk. 
VerDate Sep 11 2014 
20:45 May 11, 2016
Jkt 059200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H4063.RFS
H4063
sradovich on DSK3TPTVN1PROD with BILLS