Bill 114-HR-4063 — Health / General
Subject: Armed forces and national security

Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act or the Jason Simcakoski PROMISE Act

(Sec. 2) This bill directs the Department Veterans Affairs (VA) to expand its Opioid Safety Initiative to include all VA medical facilities.

The VA shall establish guidance that each VA health care provider, before initiating opioid therapy, use the VA Opioid Therapy Risk Report tool, which shall include: (1) information from state prescription drug monitoring programs; and (2) a patient's most recent information in order to assess the risk for adverse outcomes of opioid therapy, including the concurrent use of controlled substances such as benzodiazepines.

The VA shall establish enhanced standards for the use of routine and random urine drug tests before and during opioid therapy to help prevent substance abuse, dependence, and diversion, including that: (1) tests occur at least once each year; and (2) health care providers use the test results to tailor pain therapy, safeguards, and risk management strategies for each patient.

The VA shall use the Interdisciplinary Chronic Pain Management Training Team Program to provide education and training on pain management and safe opioid prescribing practices for managing patients with chronic pain.

In carrying out the VA Opioid Safety Initiative, each VA medical facility shall designate a pain management team of health care professionals to coordinate pain management therapy for patients experiencing acute and chronic pain that is non-cancer related. 

The VA shall establish standard protocols for the designation of pain management teams at each VA medical facility. Each protocol shall ensure that any health care provider without expertise in prescribing analgesics, or who has not completed the required education and training, does not prescribe opioids unless such health care provider:

 consults with a provider who has pain management expertise or who is on the pain management team; and refers the patient to the pain management team for subsequent prescriptions and therapy. In carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool, the VA shall:

 ensure access by VA health care providers to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the VA through a state prescription drug monitoring program; include such information in the Opioid Therapy Risk Report; and require VA health care providers to provide to a state's prescription drug monitoring program information on prescriptions of controlled substances received by veterans in that state. The VA shall report to Congress with respect to improving the VA Opioid Therapy Risk Report tool to allow for improved real-time tracking and access to data on: (1) key clinical indicators regarding the totality of veterans' opioid use, (2) concurrent prescribing by VA health care providers of opioids in different health care settings, and (3) mail-order prescriptions of opioids prescribed to veterans under VA-administered laws.

The VA shall:

 maximize the availability to veterans of Food and Drug Administration (FDA)-approved opioid receptor antagonists, including naloxone; equip each VA pharmacy with such antagonists for outpatient use; and expand the Overdose Education and Naloxone Distribution program to ensure that all veterans in receipt of VA health care who are at risk of opioid overdose may access such antagonists and training on the proper administration of such antagonists. The VA shall include in the Opioid Therapy Risk Report tool:

 information on the most recent time the tool was accessed by a VA health care provider with respect to a veteran and the results of such veteran's most recent urine drug test; and the ability of VA health care providers to determine whether a health care provider prescribed opioids to a veteran without checking tool information. The VA shall modify its computerized patient record system to ensure that any health care provider that accesses a veteran's record will be immediately notified about whether the veteran: (1) is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose, (2) has a history of opioid abuse, or (3) is at risk of becoming an opioid abuser.

(Sec. 3) The VA and the Department of Defense (DOD) shall ensure that the VA/DOD Pain Management Working Group includes a focus on:

 opioid prescribing practices; management of acute and chronic pain, including related training for health care providers; complementary and integrative health and complementary alternative medicines; concurrent use of opioids and prescription drugs to treat mental health disorders, including benzodiazepines; prescribing opioids to treat mental health disorders; coordination in coverage of and consistent access to medications prescribed for patients transitioning from DOD to VA health care; and identification and treatment of substance use disorders. The VA and DOD shall ensure that such working group: (1) coordinates with other relevant working groups, (2) consults with other relevant federal agencies, and (3) and consults with VA and DOD regarding any proposed updates to the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.

The VA and DOD shall update the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Matters to be included in such update are prescribed.

(Sec. 4) The Government Accountability Office shall, within two years, report to Congress on: (1) the VA Opioid Safety Initiative, and (2) opioid prescribing practices of VA health care providers. Such report shall include:

 improvements to the Opioid Safety Initiative; information regarding VA-prescribed opioid-related deaths, overall opioid prescription rates for non-cancer, non-palliative, and non-hospice care patients, concomitant opioid and benzodiazepine prescription rates, the prescription of opioids to patients without any pain (including non-opioid mental health disorders); the effectiveness of opioid therapy; and evaluations of the VA's oversight processes regarding veterans' opioid use and of its implementation of the VA/DOD Guideline for Management of Opioid Therapy. The VA shall: (1) report to Congress for five years regarding the prescription of opioids at each VA facility to treat non-cancer, non-palliative, and non-hospice care patients; and (2) notify Congress and conduct an investigation through the Office of the Medical Inspector if the VA determines that a prescription rate is inconsistent with safe care standards.

(Sec. 5) VA disclosure of certain information to a state controlled substance monitoring program in order to prevent misuse of prescription medicines by a veteran or dependent is made mandatory.

(Sec. 6) The Veterans Access, Choice, and Accountability Act of 2014 is amended to reduce the aggregate amount of awards and bonuses that may be paid by the VA in each of FY2017-FY2021 to $230 million.