,,ii #aadth ,,congress #ast ,session ,s4 #bbef ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #e1 #bjae ,mr4 ,kaine 7for himself and ,mrs4 ,capito7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish programs for health care provider training in ,federal health care and medical facilities1 to establish ,federal co-prescribing guidelines1 to establish a grant program with respect to naloxone1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,co-,prescribing ,saves ,lives ,act of #bjae4 #b4 ,findings ,congress finds as follows3 7#a7 ,together1 the misuse of heroin and opioids account for approximately #be1jjj deaths in the ,united ,states per year4 7#b7 ,drug overdose was the leading cause of injury death in the ,united ,states in #bjac1 and among people #be to #fd years old1 drug overdose caused more deaths than motor vehicle fatalities in #bjac4 7#c7 ,according to the ,centers for ,disease ,control and ,prevention1 in the ,united ,states1 fatal opioid-related drug overdose rates have more than quadrupled since #aiij and have never been higher4 ,each day in the ,united ,states1 #df people die from an overdose of prescription painkillers4 ,nearly #b1jjj1jjj ,americans aged #ab or older either abused or were dependent on opioids in #bjac4 7#d7 ,naloxone is a safe and effective antidote to all opioid-related overdoses1 including heroin and fentanyl1 and is a critical tool in preventing fatal opioid overdoses in both health care and at-home settings4 7#e7 ,the opioid overdose antidote naloxone has reversed more than #bf1jjj overdose cases between #aiif and #bjad1 according to the ,centers for ,disease ,control and ,prevention4 #c4 ,health care provider training in ,federal health care and medical facilities 7a7 ,guidelines 7#a7 ,,hhs guidelines ,the ,secretary of ,health and ,human ,services shall establish health care provider training guidelines for all ,federal health care facilities1 including ,federally qualified health centers 7as defined in paragraph 7#d7 of section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa777 and facilities of the ,indian ,health ,service1 and shall provide training to all providers described in subsection 7b71 in accordance with subsection 7c74 7#b7 ,department of ,veterans ,affairs guidelines ,the ,secretary of ,veterans ,affairs shall establish health care provider training guidelines for all medical facilities of the ,department of ,veterans ,affairs1 and shall provide training to all providers described in subsection 7b71 in accordance with subsection 7c74 7#c7 ,department of ,defense guidelines ,the ,secretary of ,defense shall establish health care provider training guidelines for all medical facilities of the ,department of ,defense1 and shall provide training to all providers described in subsection 7b71 in accordance with subsection 7c74 7b7 ,affected health care providers ,the guidelines developed under paragraphs 7#a7 through 7#c7 of subsection 7a7 shall ensure that training on the appropriate and effective prescribing of opioid medications is provided to all health care providers who are-- 7#a7 ,federal employees and who prescribe controlled substances as part of their official responsibilities and duties as ,federal employees2 7#b7 contractors in a health care or medical facility of an agency described in paragraph 7#a71 7#b71 or 7#c7 of subsection 7a7 who-- 7,a7 spend #ej percent or more of their clinical time under contract with the ,federal ,government2 and 7,b7 prescribe controlled substances under the terms and conditions of their contract or agreement with the ,federal ,government2 or 7#c7 clinical residents and other clinical trainees who spend #ej percent or more of their clinical time practicing in health care or medical facility of an agency described in paragraph 7#a71 7#b71 or 7#c7 of subsection 7a74 7c7 ,training requirements 7#a7 ,training topics ,the training developed under paragraphs 7#a7 through 7#c7 of subsection 7a7 shall address1 at a minimum1 best practices for appropriate and effective prescribing of pain medications1 principles of pain management1 the misuse potential of controlled substances1 identification of potential substance use disorders and referral to further evaluation and treatment1 and proper methods for disposing of controlled substances4 7#b7 ,training approaches ,the training approaches developed in accordance with this section may include both traditional continuing education models and models that pair intensive coaching for the highest volume prescribers with case-based courses for other prescribers4 7#c7 ,consistency with consensus guidelines ,to the extent practicable1 training adopted under subsection 7a7 shall be consistent with consensus guidelines on pain medication prescribing developed by the ,centers for ,disease ,control and ,prevention4 7#d7 ,training frequency ,each agency described in paragraphs 7#a7 through 7#c7 of subsection 7a7 shall provide training of the health care providers in accordance with this section not later than #ah months after the date of enactment of this ,act1 and every #c years thereafter4 7d7 ,definitions ,for purposes of this section1 the term controlled substance has the meaning given such term in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb74 #d4 ,naloxone co-prescribing in ,federal health care and medical facilities 7a7 ,naloxone co-,prescribing guidelines ,not later than #ahj days after the date of enactment of this ,act3 7#a7 ,the ,secretary of ,health and ,human ,services shall establish naloxone co-prescribing guidelines applicable to all ,federally qualified health centers 7as defined in paragraph 7#d7 of section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa777 and the health care facilities of the ,indian ,health ,service4 7#b7 ,the ,secretary of ,defense shall establish co-prescribing guidelines applicable to all ,department of ,defense medical facilities4 7#c7 ,the ,secretary of ,veterans ,affairs shall establish co-prescribing guidelines applicable to all ,department of ,veterans ,affairs medical facilities4 7b7 ,requirement ,the guidelines established under subsection 7a7 shall address naloxone co-prescribing for both pain patients receiving chronic opioid therapy and patients being treated for opioid use disorders4 7c7 ,definitions ,in this section3 7#a7 ,co-prescribing ,the term co-prescribing means1 with respect to an opioid overdose reversal drug1 the practice of prescribing such drug in conjunction with an opioid prescription for patients at an elevated risk of overdose1 or in conjunction with an opioid agonist approved under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee7 for the treatment of opioid use disorders1 or in other circumstances in which a provider identifies a patient at an elevated risk for an intentional or unintentional drug overdose from heroin or prescription opioid therapies4 7#b7 ,elevated risk of overdose ,the term elevated risk of overdose has the meaning given such term by the ,secretary of ,health and ,human ,services1 which-- 7,a7 may be based on the criteria provided in the ,opioid ,overdose ,toolkit published by the ,substance ,abuse and ,mental ,health ,services ,administration2 and 7,b7 may include patients on a first course opioid treatment1 patients using extended-release and long-acting opioid analgesic1 and patients with a respiratory disease or other co-morbidities4 #e4 ,grant program to ,state departments of health to expand naloxone co-prescribing 7a7 ,establishment ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish a competitive #d-year co-prescribing opioid overdose reversal drugs grant program to provide ,state departments of health with resources to develop and apply co-prescribing guidelines1 and to provide for increased access to naloxone4 7b7 ,application ,to be eligible to receive a grant under this section1 a ,state shall submit to the ,secretary1 in such form and manner as the ,secretary may require1 an application that-- 7#a7 identifies community partners for a co-prescribing program2 7#b7 identifies which providers will be trained in such program and the criteria that will be used to identify eligible patients to participate in such program2 and 7#c7 describes how the program will seek to identify ,state1 local1 or private funding to continue the program after expiration of the grant4 7c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to eligible ,state departments of health that propose to base ,state guidelines on guidelines on co-prescribing already in existence at the time of application1 such as guidelines of the ,department of ,veterans ,affairs or national medical societies1 such as the ,american ,society of ,addiction ,medicine or ,american ,medical ,association4 7d7 ,use of funds ,a ,state department of health receiving a grant under this section may use the grant for any of the following activities3 7#a7 ,to establish a program for co-prescribing opioid overdose reversal drugs1 such as naloxone4 7#b7 ,to expand innovative models of naloxone distribution1 as defined by the ,secretary4 7#c7 ,to train and provide resources for health care providers and pharmacists on the co-prescribing of opioid overdose reversal drugs4 7#d7 ,to establish mechanisms and processes for tracking patients participating in the program described in paragraph 7#a7 and the health outcomes of such patients1 and ensuring that health information is de-identified so as to protect patient privacy4 7#e7 ,to purchase opioid overdose reversal drugs for distribution under the program described in paragraph 7#a74 7#f7 ,to offset the copayments and other cost-sharing associated with opioid overdose reversal drugs to ensure that cost is not a limiting factor for eligible individuals1 as determined by the ,secretary and the applicable ,state department of health1 giving priority to individuals not otherwise insured for such services4 7#g7 ,to conduct community outreach1 in conjunction with community-based organizations1 designed to raise awareness of co-prescribing practices1 and the availability of opioid overdose reversal drugs4 7#h7 ,to establish protocols to connect patients who have experienced a drug overdose with appropriate treatment1 including medication assisted treatment and appropriate counseling and behavioral therapies4 ,such protocols shall be consistent with nationally recognized patient placement criteria1 such as the criteria of the ,american ,society of ,addiction ,medicine4 7e7 ,evaluations by recipients ,as a condition of receipt of a grant under this section1 a ,state department of health shall1 for each year for which grant funds are received1 submit to the ,secretary information on appropriate outcome measures specified by the ,secretary to assess the outcomes of the program funded by the grant4 7f7 ,definition ,in this section1 the term co-prescribing has the meaning given such term in section #d4 #f4 ,authorization of appropriations ,there is authorized to be appropriated to carry out this ,act #b1ejj1jjj for each of fiscal years #bjaf through #bjbj4