,,ii #aacth ,,congress #b;d ,session ,s4 #bfde ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #bc1 #bjad ,mr4 ,markey 7for himself1 ,mrs4 ,feinstein1 ,mr4 ,rockefeller1 ,mr4 ,brown1 ,ms4 ,hirono1 and ,mr4 ,durbin7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to provide access to medication-assisted therapy1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,recovery ,enhancement for ,addiction ,treatment ,act or the ,,treat ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,overdoses from opioids have increased dramatically in the ,united ,states4 7#b7 ,deaths from drug overdose1 largely from prescription pain relievers1 have tripled among men and increased five-fold among women over the past decade4 7#c7 ,nationwide1 drug overdoses now claim more lives than car accidents4 7#d7 ,opioid addiction is a chronic disease that1 untreated1 places a large burden on the healthcare system4 ,roughly #dge1jjj emergency room visits each year are attributable to the misuse and abuse of opioid pain medication4 7#e7 ,effective medication-assisted treatment for opioid addiction can decrease overdose deaths1 be cost-effective1 reduce transmissions of ,,hiv and viral hepatitis1 and reduce other social harms such as criminal activity4 7#f7 ,effective medication-assisted treatment programs for opioid addiction should include multiple components1 including medications1 cognitive and behavioral supports and interventions1 and drug testing4 7#g7 ,effective medication-assisted treatment programs for opioid addiction may use a team of staff members1 in addition to a prescribing provider1 to deliver comprehensive care4 7#h7 ,access to medication-assisted treatments1 including office-based buprenorphine opioid treatment1 remains limited in part due to current practice regulations and an insufficient number of providers4 7#i7 ,more than #aj years of experience in the ,united ,states with office-based buprenorphine opioid treatment has informed best practices for delivering successful1 high quality care4 #c4 ,expansion of patient limits under waiver ,section #cjc7;g77#b77;,b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,b77 is amended-- 7#a7 in clause 7i71 by striking physician and inserting practitioner2 7#b7 in clause 7iii7-- 7,a7 by striking #cj and inserting #ajj2 and 7,b7 by striking 1 unless1 not sooner and all that follows through the end and inserting a period2 and 7#c7 by inserting at the end the following new clause3 7iv7 ,not earlier than #a year after the date on which a qualifying practitioner obtained an initial waiver pursuant to clause 7iii71 the qualifying practitioner may submit a second notification to the ,secretary of the need and intent of the qualifying practitioner to treat an unlimited number of patients1 if the qualifying practitioner-- 7,i7 7aa7 satisfies the requirements of item 7aa71 7bb71 7cc71 or 7dd7 of subparagraph 7,g77ii77,i72 and 7bb7 agrees to fully participate in the ,prescription ,drug ,monitoring ,program of the ,state in which the qualifying practitioner is licensed1 pursuant to applicable ,state guidelines2 or 7,,ii7 7aa7 satisfies the requirements of item 7ee71 7ff71 or 7gg7 of subparagraph 7,g77ii77,i72 7bb7 agrees to fully participate in the ,prescription ,drug ,monitoring ,program of the ,state in which the qualifying practitioner is licensed1 pursuant to applicable ,state guidelines2 7cc7 practices in a qualified practice setting2 and 7dd7 has completed not less than #bd hours of training 7through classroom situations1 seminars at professional society meetings1 electronic communications1 or otherwise7 with respect to the treatment and management of opiate-dependent patients for substance use disorders provided by the ,american ,society of ,addiction ,medicine1 the ,american ,academy of ,addiction ,psychiatry1 the ,american ,medical ,association1 the ,american ,osteopathic ,association1 the ,american ,psychiatric ,association1 or any other organization that the ,secretary determines is appropriate for purposes of this subclause4 4 #d4 ,definitions ,section #cjc7;g77#b77;,g7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77 is amended-- 7#a7 by striking clause 7ii7 and inserting the following3 7ii7 ,the term qualifying practitioner means the following3 7,i7 ,a physician who is licensed under ,state law and who meets #a or more of the following conditions3 7aa7 ,the physician holds a board certification in addiction psychiatry from the ,american ,board of ,medical ,specialties4 7bb7 ,the physician holds an addiction certification from the ,american ,society of ,addiction ,medicine4 7cc7 ,the physician holds a board certification in addiction medicine from the ,american ,osteopathic ,association4 7dd7 ,the physician holds a board certification from the ,american ,board of ,addiction ,medicine4 7ee7 ,the physician has completed not less than #h hours of training 7through classroom situations1 seminar at professional society meetings1 electronic communications1 or otherwise7 with respect to the treatment and management of opiate-dependent patients for substance use disorders provided by the ,american ,society of ,addiction ,medicine1 the ,american ,academy of ,addiction ,psychiatry1 the ,american ,medical ,association1 the ,american ,osteopathic ,association1 the ,american ,psychiatric ,association1 or any other organization that the ,secretary determines is appropriate for purposes of this subclause4 7ff7 ,the physician has participated as an investigator in #a or more clinical trials leading to the approval of a narcotic drug in schedule ,,iii1 ,,iv1 or ,v for maintenance or detoxification treatment1 as demonstrated by a statement submitted to the ,secretary by this sponsor of such approved drug4 7gg7 ,the physician has such other training or experience as the ,secretary determines will demonstrate the ability of the physician to treat and manage opiate-dependent patients4 7,,ii7 ,a nurse practitioner or physician assistant who is licensed under ,state law and meets all of the following conditions3 7aa7 ,the nurse practitioner or physician assistant is licensed under ,state law to prescribe schedule ,,iii1 ,,iv1 or ,v medications for pain4 7bb7 ,the nurse practitioner or physician assistant satisfies #a or more of the following3 7,,aa7 ,has completed not fewer than #bd hours of training 7through classroom situations1 seminar at professional society meetings1 electronic communications1 or otherwise7 with respect to the treatment and management of opiate-dependent patients for substance use disorders provided by the ,american ,society of ,addiction ,medicine1 the ,american ,academy of ,addiction ,psychiatry1 the ,american ,medical ,association1 the ,american ,osteopathic ,association1 the ,american ,psychiatric ,association1 or any other organization that the ,secretary determines is appropriate for purposes of this subclause4 7,,bb7 ,has such other training or experience as the ,secretary determines will demonstrate the ability of the nurse practitioner or physician assistant to treat and manage opiate-dependent patients4 7cc7 ,the nurse practitioner or physician assistant practices under the supervision of a licensed physician who holds an active waiver to prescribe schedule ,,iii1 ,,iv1 or ,v narcotic medications for opioid addiction therapy1 and-- 7,,aa7 the supervising physician satisfies the conditions of item 7aa71 7bb71 7cc71 or 7dd7 of subclause 7,i72 or 7,,bb7 both the supervising physician and the nurse practitioner or physician assistant practice in a qualified practice setting4 7,,iii7 ,a nurse practitioner who is licensed under ,state law and meets all of the following conditions3 7aa7 ,the nurse practitioner is licensed under ,state law to prescribe schedule ,,iii1 ,,iv1 or ,v medications for pain4 7bb7 ,the nurse practitioner has training or experience that the ,secretary determines demonstrates specialization in the ability to treat opiate-dependent patients1 such as a certification in addiction specialty accredited by the ,american ,board of ,nursing ,specialties or the ,national ,commission for ,certifying ,agencies1 or a certification in addiction nursing as a ,certified ,addiction ,registered ,nurse--,advanced ,practice4 7cc7 ,in accordance with ,state law1 the nurse practitioner prescribes opioid addiction therapy in collaboration with a physician who holds an active waiver to prescribe schedule ,,iii1 ,,iv1 or ,v narcotic medications for opioid addiction therapy4 7dd7 ,the nurse practitioner practices in a qualified practice setting4 2 and 7#b7 by adding at the end the following3 7iii7 ,the term qualified practice setting means #a or more of the following treatment settings3 7,i7 ,a ,national ,committee for ,quality ,assurance-recognized ,patient-,centered ,medical ,home or ,patient-,centered ,specialty ,practice4 7,,ii7 ,a ,centers for ,medicaid ,medicare ,services-recognized ,accountable ,care ,organization4 7,,iii7 ,a clinical facility administered by the ,department of ,veterans ,affairs1 ,department of ,defense1 or ,indian ,health ,service4 7,,iv7 ,a ,behavioral ,health ,home accredited by the ,joint ,commission4 7,v7 ,a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 or a ,federally-qualified health center look-alike4 7,,vi7 ,a ,substance ,abuse and ,mental ,health ,services-certified ,opioid ,treatment ,program4 7,,vii7 ,a clinical program of a ,state or ,federal jail1 prison1 or other facility where individuals are incarcerated4 7,,viii7 ,a clinic that demonstrates compliance with the ,model ,policy on ,,data #bjjj and ,treatment of ,opioid ,addiction in the ,medical ,office issued by the ,federation of ,state ,medical ,boards4 7,,ix7 ,a treatment setting that is part of an ,accreditation ,council for ,graduate ,medical ,education1 ,american ,association of ,colleges of ,osteopathic ,medicine1 or ,american ,osteopathic ,association-accredited residency or fellowship training program4 7,x7 ,any other practice setting approved by a ,state regulatory board or ,state ,medicaid ,plan to provide addiction treatment services4 7,,xi7 ,any other practice setting approved by the ,secretary4 4 #e4 ,,gao ,evaluation ,two years after the date on which the first notification under clause 7iv7 of section #cjc7;g77#b77;,b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,b771 as added by this ,act1 is received by the ,secretary of ,health and ,human ,services1 the ,comptroller ,general of the ,united ,states shall initiate an evaluation of the effectiveness of the amendments made by this ,act1 which shall include an evaluation of-- 7#a7 any changes in the availability and use of medication-assisted treatment for opioid addiction2 7#b7 the quality of medication-assisted treatment programs2 7#c7 the integration of medication-assisted treatment with routine healthcare services2 7#d7 diversion of opioid addiction treatment medication2 7#e7 changes in ,state or local policies and legislation relating to opioid addiction treatment2 7#f7 the use of nurse practitioners and physician assistants who prescribe opioid addiction medication2 7#g7 the use of ,prescription ,drug ,monitoring ,programs by waived practitioners to maximize safety of patient care and prevent diversion of opioid addiction medication2 7#h7 the findings of ,drug ,enforcement ,agency inspections of waived practitioners1 including the frequency with which the ,drug ,enforcement ,agency finds no documentation of access to behavioral health services2 and 7#i7 the effectiveness of cross-agency collaboration between ,department of ,health and ,human ,services and the ,drug ,enforcement ,agency for expanding effective opioid addiction treatment4