#aadth ,,congress  #b;d ,session  ,h4   
,r4 #djfc  ,,an ,,act  ,to improve the  
use by the ,secretary of ,veterans      
,affairs of opioids in treating         
veterans1 and for other purposes4  #a4  
,short title ,this ,act may be cited as 
the ,promoting ,responsible ,opioid     
,management and ,incorporating          
,scientific ,expertise ,act or the      
,jason ,simcakoski ,,promise ,act4  #b4 
,improvement of opioid safety measures  
by ,department of ,veterans ,affairs    
7a7 ,expansion of opioid safety         
initiative  7#a7 ,inclusion of all      
medical facilities ,not later than #ahj 
days after the date of the enactment of 
this ,act1 the ,secretary of ,veterans  
,affairs shall expand the ,opioid       
,safety ,initiative of the ,department  
of ,veterans ,affairs to include all    
medical facilities of the ,department4  
7#b7 ,guidance ,the ,secretary shall    
establish guidance that each health care
 provider of the ,department of         
,veterans ,affairs1 before initiating   

opioid therapy to treat a patient as    
part of the comprehensive assessment    
conducted by the health care provider1  
use the ,opioid ,therapy ,risk ,report  
tool of the ,department of ,veterans    
,affairs 7or any subsequent tool71 which
 shall include information from the     
prescription drug monitoring program of 
each participating ,state as applicable1
 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 patient1         
including the concurrent use of         
controlled substances such as           
benzodiazepines1 as part of the         
comprehensive assessment conducted by   
the health care provider4  7#c7         
,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 abuse1 dependence1   

and diversion1 including--  7,a7 that   
such tests occur not less frequently    
than once each year2 and  7,b7 that     
health care providers appropriately     
order1 interpret and respond to the     
results from such tests to tailor pain  
therapy1 safeguards1 and risk management
 strategies to each patient4  7b7 ,pain 
management education and training  7#a7 
,in general ,in carrying out the ,opioid
 ,safety ,initiative of the ,department1
 the ,secretary shall require all       
employees of the ,department responsible
 for prescribing opioids to receive     
education and training described in     
paragraph 7#b74  7#b7 ,education and    
training ,education and training        
described in this paragraph is education
 and training on pain management and    
safe opioid prescribing practices for   
purposes of safely and effectively      
managing patients with chronic pain1    
including education and training on the 
following3  7,a7 ,the implementation of 
and full compliance with the ,,va_/,,dod

 ,clinical ,practice ,guideline for     
,management of ,opioid ,therapy for     
,chronic ,pain1 including any update to 
such guideline4  7,b7 ,the use of       
evidence-based pain management          
therapies1 including                    
cognitive-behavioral therapy1 non-opioid
 alternatives1 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 patients with chronic pain 
and complementary alternative medicines4
  7,c7 ,screening and identification of 
patients with substance use disorder1   
including drug-seeking behavior1 before 
prescribing opioids1 assessment of risk 
potential for patients developing an    
addiction1 and referral of patients to  
appropriate addiction treatment         
professionals if addiction is identified
 or strongly suspected4  7,d7           
,communication with patients on the     
potential harm associated with the use  

of opioids and other controlled         
substances1 including the need to safely
 store and dispose of supplies relating 
to the use of opioids and other         
controlled substances4  7,e7 ,such other
 education and training as the          
,secretary considers appropriate to     
ensure that veterans receive safe and   
high-quality pain management care from  
the ,department4  7#c7 ,use of existing 
program ,in providing education and     
training described in paragraph 7#b71   
the ,secretary shall use the            
,interdisciplinary ,chronic ,pain       
,management ,training ,team ,program of 
the ,department 7or success program74   
7c7 ,pain management teams  7#a7 ,in    
general ,in carrying out the ,opioid    
,safety ,initiative of the ,department1 
the director of each medical facility of
 the ,department shall identify and     
designate a pain management team of     
health care professionals1 which may    
include board certified pain medicine   
specialists1 responsible for            

coordinating and overseeing pain        
management therapy at such facility for 
patients experiencing acute and chronic 
pain that is non-cancer related4  7#b7  
,establishment of protocols  7,a7 ,in   
general ,in consultation with the       
,directors of each ,veterans ,integrated
 ,service ,network1 the ,secretary shall
 establish standard protocols for the   
designation of pain management teams at 
each medical facility within the        
,department4  7,b7 ,consultation on     
prescription of opioids ,each protocol  
established under subparagraph 7,a7     
shall ensure that any health care       
provider without expertise in           
prescribing analgesics or who has not   
completed the education and training    
under subsection 7b71 including a mental
 health care provider1 does not         
prescribe opioids to a patient unless   
that health care provider-- 7i7 consults
 with a health care provider with pain  
management expertise or who is on the   
pain management team of the medical     

facility2 and  7ii7 refers the patient  
to the pain management team for any     
subsequent prescriptions and related    
therapy4  7#c7 ,report  7,a7 ,in general
 ,not later than #a year after the date 
of enactment of this ,act1 the director 
of each medical facility of the         
,department shall submit to the ,under  
,secretary for ,health and the director 
of the ,veterans ,integrated ,service   
,network in which the medical facility  
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 7#a74  7,b7       
,elements ,each report submitted under  
subparagraph 7,a7 with respect to a     
medical facility of the ,department     
shall include-- 7i7 a certification as  
to whether all members of the pain      
management team at the medical facility 
have completed the education and        
training required under subsection 7b72 
7ii7 a plan for the management and      

referral of patients to such pain       
management team if health care providers
 without expertise in prescribing       
analgesics prescribe opioid medications 
to treat acute and chronic pain that is 
non-cancer related2 and  7iii7 a        
certification as to whether the medical 
facility--  7,i7 fully complies with the
 stepped-care model of pain management  
and other pain management policies      
contained in ,directive #bjji-jec of the
 ,veterans ,health ,administration1 or  
successor directive2 or  7,,ii7 does not
 fully comply with such stepped-care    
model of pain management and other pain 
management policies but is carrying out 
a corrective plan of action to ensure   
such full compliance4  7d7 ,tracking and
 monitoring of opioid use  7#a7         
,prescription drug monitoring programs  
of states ,in carrying out the ,opioid  
,safety ,initiative and the ,opioid     
,therapy ,risk ,report tool of the      
,department1 the ,secretary shall-- 7,a7
 ensure access by health care providers 

of the ,department to information on    
controlled substances1 including opioids
 and benzodiazepines1 prescribed to     
veterans who receive care outside the   
,department through the prescription    
drug monitoring program of each ,state  
with such a program1 including by       
seeking to enter into memoranda of      
understanding with ,states to allow     
shared access of such information       
between ,states and the ,department2    
7,b7 include such information in the    
,opioid ,therapy ,risk ,report2 and     
7,c7 require health care providers of   
the ,department to submit to the        
prescription drug monitoring program of 
each ,state information on prescriptions
 of controlled substances received by   
veterans in that ,state under the laws  
administered by the ,secretary4  7#b7   
,report on tracking of data on opioid   
use ,not later than #ah months after the
 date of the enactment of this ,act1 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-- 7,a7 the key   
clinical indicators with respect to the 
totality of opioid use by veterans2     
7,b7 concurrent prescribing by health   
care providers of the ,department of    
opioids in different health care        
settings1 including data on concurrent  
prescribing of opioids to treat mental  
health disorders other than opioid use  
disorder2 and  7,c7 mail-order          
prescriptions of opioid prescribed to   
veterans under the laws administered by 
the ,secretary4  7e7 ,availability of   
opioid receptor antagonists  7#a7       
,increased availability and use  7,a7   
,in general ,the ,secretary shall       
maximize the availability of opioid     
receptor antagonists approved by the    

,food and ,drug ,administration1        
including naloxone1 to veterans4  7,b7  
,availability1 training1 and            
distributing ,in carrying out           
subparagraph 7,a71 not later than #ij   
days after the date of the enactment of 
this ,act1 the ,secretary shall--  7i7  
equip each pharmacy of the ,department  
with opioid receptor antagonists        
approved by the ,food and ,drug         
,administration to be dispensed to      
outpatients as needed2 and  7ii7 expand 
the ,overdose ,education and ,naloxone  
,distribution program of the ,department
 to ensure that all veterans in receipt 
of health care under laws administered  
by the ,secretary who are at risk of    
opioid overdose may access such opioid  
receptor antagonists and training on the
 proper administration of such opioid   
receptor antagonists4  7,c7 ,veterans   
who are at risk ,for purposes of        
subparagraph 7,b71 veterans who are at  
risk of opioid overdose include-- 7i7   
veterans receiving long-term opioid     

therapy2  7ii7 veterans receiving opioid
 therapy who have a history of substance
 use disorder or prior instances of     
overdose2 and  7iii7 veterans who are at
 risk as determined by a health care    
provider who is treating the veteran4   
7#b7 ,report ,not later than #abj days  
after the date of the enactment of this 
,act1 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 carrying   
out paragraph 7#a71 including an        
assessment of any remaining steps to be 
carried out by the ,secretary to carry  
out such paragraph4  7f7 ,inclusion of  
certain information and capabilities in 
opioid therapy risk report tool of the  
,department  7#a7 ,information ,the     
,secretary shall include in the ,opioid 
,therapy ,risk ,report tool of the      
,department--  7,a7 information on the  
most recent time the tool was accessed  
by a health care provider of the        

,department with respect to each        
veteran2 and  7,b7 information on the   
results of the most recent urine drug   
test for each veteran4  7#b7            
,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 ,department prescribed opioids  
to a veteran without checking the       
information in the tool with respect to 
the veteran4  7g7 ,notifications of risk
 in computerized health record ,the     
,secretary shall modify the computerized
 patient record system of the           
,department to ensure that any health   
care provider that accesses the record  
of a veteran1 regardless of the reason  
the veteran seeks care from the health  
care provider1 will be immediately      
notified whether the veteran--  7#a7 is 
receiving opioid therapy and has a      
history of substance use disorder or    
prior instances of overdose2  7#b7 has a

 history of opioid abuse2 or  7#c7 is at
 risk of becoming an opioid abuser as   
determined by a health care provider who
 is treating the veteran4  7h7          
,definitions ,in this section3  7#a7    
,the term controlled substance has the  
meaning given that term in section #ajb 
of the ,controlled ,substances ,act 7#ba
 ,u4,s4,c4 #hjb74  7#b7 ,the term ,state
 means each of the several ,states1     
territories1 and possessions of the     
,united ,states1 the ,district of       
,columbia1 and the ,commonwealth of     
,puerto ,rico4  #c4 ,strengthening of   
joint working group on pain management  
of the ,department of ,veterans ,affairs
 and the ,department of ,defense  7a7   
,in general ,not later than #ij days    
after the date of enactment of this     
,act1 the ,secretary of ,veterans       
,affairs and the ,secretary of ,defense 
shall ensure that the ,pain ,management 
,working ,group of the ,health          
,executive ,committee of the ,department
 of ,veterans ,affairs-,department of   

,defense ,joint ,executive ,committee   
7,pain ,management ,working ,group7     
established under section #cbj of title 
#ch1 ,united ,states ,code1 includes a  
focus on the following3 7#a7 ,the opioid
 prescribing practices of health care   
providers of each ,department4  7#b7    
,the ability of each ,department to     
manage acute and chronic pain among     
individuals receiving health care from  
the ,department1 including training     
health care providers with respect to   
pain management4  7#c7 ,the use by each 
,department of complementary and        
integrative health and complementary    
alternative medicines in treating such  
individuals4  7#d7 ,the concurrent use  
by health care providers of each        
,department of opioids and prescription 
drugs to treat mental health disorders1 
including benzodiazepines4  7#e7 ,the   
practice by health care providers of    
each ,department of prescribing opioids 
to treat mental health disorders4  7#f7 
,the coordination in coverage of and    

consistent 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 ,affairs4  7#g7 ,the ability  
of each ,department to identify and     
treat substance use disorders among     
individuals receiving health care from  
that ,department4  7b7 ,coordination and
 consultation ,the ,secretary of        
,veterans ,affairs and the ,secretary of
 ,defense shall ensure that the working 
group described in subsection 7a7-- 7#a7
 coordinates the activities of the      
working group with other relevant       
working groups established under section
 #cbj of title #ch1 ,united ,states     
,code2  7#b7 consults with other        
relevant ,federal agencies with respect 
to the activities of the working group2 
and  7#c7 consults with the ,department 
of ,veterans ,affairs and the           
,department of ,defense with respect to1
 reviews1 and comments on the           

,,va_/,,dod ,clinical ,practice         
,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain1 or any     
successor guideline1 before any update  
to the guideline is released4  7c7      
,clinical practice guidelines  7#a7 ,in 
general ,not later than #ahj days after 
the date of the enactment of this ,act1 
the ,secretary of ,veterans ,affairs and
 the ,secretary of ,defense shall issue 
an update to the ,,va_/,,dod ,clinical  
,practice ,guideline for ,management of 
,opioid ,therapy for ,chronic ,pain4    
7#b7 ,matters included ,in conducting   
the update under subsection 7a71 the    
,pain ,management ,working ,group1 in   
coordination with the ,clinical         
,practice ,guideline ,,va_/,,dod        
,management of ,opioid ,therapy for     
,chronic ,pain ,working ,group1 shall   
examine whether the ,clinical ,practical
 ,guideline should include the          
following3  7,a7 ,enhanced guidance with
 respect to-- 7i7 the coadministration  
of an opioid and other drugs1 including 

benzodiazepines1 that may result in     
life-limiting drug interactions2  7ii7  
the treatment of patients with current  
acute psychiatric instability or        
substance use disorder or patients at   
risk of suicide2 and  7iii7 the use of  
opioid therapy to treat mental health   
disorders other than opioid use         
disorder4  7,b7 ,enhanced guidance with 
respect to the treatment of patients    
with behaviors or comorbidities1 such as
 post-traumatic stress disorder or other
 psychiatric disorders1 or a history of 
substance abuse or addiction1 that      
requires a consultation or comanagement 
of opioid therapy with one or more      
specialists in pain management1 mental  
health1 or addictions4  7,c7 ,enhanced  
guidance with respect to health care    
providers--  7i7 conducting an effective
 assessment for patients beginning or   
continuing opioid therapy1 including    
understanding and setting realistic     
goals with respect to achieving and     
maintaining an expected level of pain   

relief1 improved function1 or a         
clinically appropriate combination of   
both2 and  7ii7 effectively assessing   
whether opioid therapy is achieving or  
maintaining the established treatment   
goals of the patient or whether the     
patient and health care provider should 
discuss adjusting1 augmenting1 or       
discontinuing the opioid therapy4  7,d7 
,guidelines to govern the methodologies 
used by health care providers of the    
,department of ,veterans ,affairs and   
the ,department of ,defense to taper    
opioid therapy when adjusting or        
discontinuing the use of opioid therapy4
  7,e7 ,guidelines with respect to      
appropriate case management for patients
 receiving opioid therapy who transition
 between inpatient and outpatient health
 care settings1 which may include the   
use of care transition plans4  7,f7     
,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 networks4     
7,g7 ,guidelines with respect to        
providing options1 before initiating    
opioid therapy1 for pain management     
therapies without the use of opioids and
 options to augment opioid therapy with 
other clinical and complementary and    
integrative health services to minimize 
opioid dependence4  7,h7 ,guidelines    
with respect to the provision of        
evidence-based non-opioid treatments    
within the ,department of ,veterans     
,affairs and the ,department of         
,defense1 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     
therapy4  #d4 ,review1 investigation1   
and report on use of opioids in         
treatment by ,department of ,veterans   
,affairs  7a7 ,comptroller general      
report  7#a7 ,in general ,not later than
 #b years after the date of the         
enactment of this ,act1 the ,comptroller

 ,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 ,affairs and   
the opioid prescribing practices of     
health care providers of the            
,department4  7#b7 ,elements ,the report
 submitted under paragraph 7#a7 shall   
include the following3 7,a7             
,recommendations on such improvements to
 the ,opioid ,safety ,initiative of the 
,department as the ,comptroller ,general
 considers appropriate4  7,b7           
,information with respect to-- 7i7      
deaths resulting from sentinel events   
involving veterans prescribed opioids by
 a health care provider of the          
,department2  7ii7 overall prescription 
rates and prescriptions indications of  
opioids to treat non-cancer1            
non-palliative1 and non-hospice care    
patients2  7iii7 the prescription rates 

and prescriptions indications of        
benzodiazepines and opioids             
concomitantly by health care providers  
of the ,department2  7iv7 the practice  
by health care providers of the         
,department of prescribing opioids to   
treat patients without any pain1        
including to treat patients with mental 
health disorders other than opioid use  
disorder2 and  7v7 the effectiveness of 
opioid therapy for patients receiving   
such therapy1 including the             
effectiveness of long-term opioid       
therapy4  7,c7 ,an evaluation of        
processes of the ,department in place to
 oversee opioid use among veterans1     
including procedures to identify and    
remedy potential over-prescribing of    
opioids by health care providers of the 
,department4  7,d7 ,an assessment of the
 implementation by the ,secretary of the
 ,,va_/,,dod ,clinical ,practice        
,guideline for ,management of ,opioid   
,therapy for ,chronic ,pain4  7b7       
,quarterly progress report on           

implementation of comptroller general   
recommendations ,not later than #b years
 after the date of the enactment of this
 ,act1 and not later than #cj days after
 the end of each quarter thereafter1 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 recommendations by the     
,comptroller ,general of the ,united    
,states under subsection 7a7 with       
respect to the ,veterans ,health        
,administration4  7c7 ,annual review of 
prescription rates ,not later than #a   
year after the date of the enactment of 
this ,act1 and not less frequently than 
annually for the following #e years1 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 report1 with respect 
to each medical facility of the         
,department of ,veterans ,affairs1 to   
collect and review information on       
opioids prescribed by health care       
providers at the facility to treat      
non-cancer1 non-palliative1 and         
non-hospice care patients that contains1
 for the #a-year period preceding the   
submission of the report1 the following3
  7#a7 ,the number of patients and the  
percentage of the patient population of 
the ,department who were prescribed     
benzodiazepines and opioids concurrently
 by a health care provider of the       
,department4  7#b7 ,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
 ,department1 including those who were  
prescribed benzodiazepines and opioids  
concurrently4  7#c7 ,the number of      
non-cancer1 non-palliative1 and         

non-hospice care patients and the       
percentage of such patients who were    
treated with opioids by a health care   
provider of the ,department on an       
inpatient-basis and who also received   
prescription opioids by mail from the   
,department while being treated on an   
inpatient-basis4  7#d7 ,the number of   
non-cancer1 non-palliative1 and         
non-hospice care patients and the       
percentage of such patients who were    
prescribed opioids concurrently by a    
health care provider of the ,department 
and a health care provider that is not  
health care provider of the ,department4
  7#e7 ,with respect to each medical    
facility of the ,department1 information
 on opioids prescribed by health care   
providers at the facility to treat      
non-cancer1 non-palliative1 and         
non-hospice care patients1 including    
information on-- 7,a7 the prescription  
rate at which each health care provider 
at the facility prescribed              
benzodiazepines and opioids concurrently

 to such patients and the aggregate such
 prescription rate for all health care  
providers at the facility2  7,b7 the    
prescription rate at which each health  
care provider at the facility prescribed
 benzodiazepines or opioids to such     
patients to treat conditions for which  
benzodiazepines or opioids are not      
approved treatment and the aggregate    
such prescription rate for all health   
care providers at the facility2  7,c7   
the prescription rate at which each     
health care provider at the facility    
prescribed or dispensed mail-order      
prescriptions of opioids to such        
patients while such patients were being 
treated with opioids on an              
inpatient-basis and the aggregate of    
such prescription rate for all health   
care providers at the facility2 and     
7,d7 the prescription rate at which each
 health care provider at the facility   
prescribed opioids to such patients who 
were also concurrently prescribed       
opioids by a health care provider that  

is not a health care provider of the    
,department and the aggregate of such   
prescription rates for all health care  
providers at the facility4  7#f7 ,with  
respect to each medical facility of the 
,department1 the number of times a      
pharmacist at the facility overrode a   
critical drug interaction warning with  
respect to an interaction between       
opioids and another medication before   
dispensing such medication to a veteran4
  7d7 ,investigation of prescription    
rates ,if the ,secretary determines that
 a prescription rate with respect to a  
health care provider or medical facility
 of the ,department conflicts with or is
 otherwise inconsistent with the        
standards of appropriate and safe care1 
the ,secretary shall-- 7#a7 immediately 
notify the ,committee on ,veterans'     
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives of such     
determination1 including information    
relating to such determination1         

prescription rate1 and health care      
provider or medical facility1 as the    
case may be2 and  7#b7 through the      
,office of the ,medical ,inspector of   
the ,veterans ,health ,administration1  
conduct a full investigation of the     
health care provider or medical         
facility1 as the case may be4  7e7      
,prescription rate defined ,in this     
section1 the term prescription rate     
means1 with respect to a health care    
provider or medical facility of the     
,department1 each of the following3     
7#a7 ,the number of patients treated    
with opioids by the health care provider
 or at the medical facility1 as the case
 may be1 divided by the total number of 
pharmacy users of that health care      
provider or medical facility4  7#b7 ,the
 average number of morphine equivalents 
per day prescribed by the health care   
provider or at the medical facility1 as 
the case may be1 to patients being      
treated with opioids4  7#c7 ,of the     
patients being treated with opioids by  

the health care provider or at the      
medical facility1 as the case may be1   
the average number of prescriptions of  
opioids per patient4  #e4 ,mandatory    
disclosure of certain veteran           
information to ,state controlled        
substance monitoring programs ,section  
#egja7l7 of title #ch1 ,united ,states  
,code1 is amended by striking may and   
inserting shall4  #f4 ,modification to  
limitation on awards and bonuses        
,section #gje of the ,veterans ,access1 
,choice1 and ,accountability ,act of    
#bjad 7,public ,law #aac-adf2 #ch       
,u4,s4,c4 #gjc note7 is amended to read 
as follows3  #gje4 ,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 #de or #ec of title #e1 ,united 
,states ,code1 or any other awards or   
bonuses authorized under such title or  

title #ch1 ,united ,states ,code1 does  
not exceed the following amounts3  7#a7 
,with respect to each of fiscal years   
#bjag through #bjba1 #bcj1jjj1jjj4  7#b7
 ,with respect to each of fiscal years  
#bjbb through #bjbd1 #cfj1jjj1jjj4  4   
,passed the ,house of ,representatives  
,may #aj1 #bjaf4;,clerk4