MATE Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4974 To amend the Controlled Substances Act to require physicians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treat- ment), and for other purposes. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 1, 2019 Mrs. TRAHAN (for herself, Mr. BERGMAN, Mr. CARTER of Georgia, Mr. TRONE, Mr. ROGERS of Kentucky, Ms. KUSTER of New Hampshire, Mr. TONKO, Mr. CROW, Mr. ROSE of New York, and Mr. PAPPAS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on the Judiciary, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration of such provisions as fall within the jurisdiction of the com- mittee concerned A BILL To amend the Controlled Substances Act to require physi- cians and other prescribers of controlled substances to complete training on treating and managing patients with opioid and other substance use disorders (which shall also satisfy certain training required to receive a waiver for dispensing narcotic drugs for maintenance or detoxification treatment), and for other purposes. VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 2 •HR 4974 IH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medication Access and 4 Training Expansion Act of 2019’’ or the ‘‘MATE Act of 5 2019’’. 6 SEC. 2. REQUIRING PRESCRIBERS OF CONTROLLED SUB- 7 STANCES TO COMPLETE TRAINING ON 8 TREATING AND MANAGING PATIENTS WITH 9 OPIOID AND OTHER SUBSTANCE USE DIS- 10 ORDERS. 11 (a) IN GENERAL.—Section 303 of the Controlled 12 Substances Act (21 U.S.C. 823) is amended by adding at 13 the end the following: 14 ‘‘(l) REQUIRED TRAINING FOR PRESCRIBERS ON 15 TREATING AND MANAGING PATIENTS WITH OPIOID AND 16 OTHER SUBSTANCE USE DISORDERS.— 17 ‘‘(1) APPLICABILITY.—This subsection ap- 18 plies— 19 ‘‘(A) with respect to any practitioner who 20 is licensed under State law to prescribe con- 21 trolled substances; and 22 ‘‘(B) beginning with the first registration 23 or renewal of registration by the practitioner 24 under this section occurring 90 or more days 25 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 3 •HR 4974 IH after the date of enactment of the Medication 1 Access and Training Expansion Act of 2019. 2 ‘‘(2) TRAINING REQUIRED.—As a condition on 3 registration under this section to dispense controlled 4 substances in schedule II, III, IV, or V, the Attorney 5 General shall require any practitioner described in 6 paragraph (1)(A) to meet the following: 7 ‘‘(A) If the practitioner is a physician, the 8 practitioner must meet one or more of the fol- 9 lowing conditions: 10 ‘‘(i) The physician holds a board cer- 11 tification in addiction psychiatry or addic- 12 tion medicine from the American Board of 13 Medical Specialties. 14 ‘‘(ii) The physician holds an addiction 15 certification or board certification from the 16 American Society of Addiction Medicine or 17 the American Board of Addiction Medicine. 18 ‘‘(iii) The physician holds a board cer- 19 tification in addiction medicine from the 20 American Osteopathic Association. 21 ‘‘(iv) The physician has, with respect 22 to the treatment and management of pa- 23 tients with opioid and other substance use 24 disorders, completed not less than 8 hours 25 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 4 •HR 4974 IH of training (through classroom situations, 1 seminars at professional society meetings, 2 electronic communications, or otherwise) 3 that is provided by the American Society of 4 Addiction Medicine, the American Acad- 5 emy of Addiction Psychiatry, the American 6 Medical Association, the American Osteo- 7 pathic Association, the American Psy- 8 chiatric Association, or any other organiza- 9 tion that the Secretary determines is ap- 10 propriate for purposes of this clause. Such 11 training shall include— 12 ‘‘(I) opioid maintenance and de- 13 toxification; 14 ‘‘(II) appropriate clinical use of 15 all drugs approved by the Food and 16 Drug Administration for the treat- 17 ment of a substance use disorder; 18 ‘‘(III) initial and periodic patient 19 assessments (including substance use 20 monitoring); 21 ‘‘(IV) individualized treatment 22 planning, overdose reversal, and re- 23 lapse prevention; 24 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 5 •HR 4974 IH ‘‘(V) counseling and recovery 1 support services; 2 ‘‘(VI) staffing roles and consider- 3 ations; 4 ‘‘(VII) diversion control; and 5 ‘‘(VIII) other best practices, such 6 as prevention of addiction, as identi- 7 fied by the Secretary, after consulta- 8 tion with practitioners from a variety 9 of medical specialties and who prac- 10 tice in different settings in which con- 11 trolled substances are prescribed. 12 ‘‘(v) The physician has participated as 13 an investigator in one or more clinical 14 trials leading to the approval of a narcotic 15 drug in schedule III, IV, or V for mainte- 16 nance or detoxification treatment, as dem- 17 onstrated by a statement submitted to the 18 Secretary by the sponsor of such approved 19 drug. 20 ‘‘(vi) The physician has such other 21 training or experience as the State medical 22 licensing board of the State where the phy- 23 sician will provide maintenance or detoxi- 24 fication treatment considers to dem- 25 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 6 •HR 4974 IH onstrate the ability of the physician to 1 treat and manage patients with opioid and 2 other substance use disorders. 3 ‘‘(vii) The physician has such other 4 training or experience as the Secretary 5 considers to demonstrate the ability of the 6 physician to treat and manage patients 7 with opioid and other substance use dis- 8 orders. Any criteria of the Secretary under 9 this clause shall be established by regula- 10 tion. Any such criteria are effective only 11 for 3 years after the date on which the cri- 12 teria are promulgated, but may be ex- 13 tended for such additional discrete 3-year 14 periods as the Secretary considers appro- 15 priate for purposes of this clause. Such an 16 extension of criteria may only be effec- 17 tuated through a statement published in 18 the Federal Register by the Secretary dur- 19 ing the 30-day period preceding the end of 20 the 3-year period involved. 21 ‘‘(viii) The physician graduated in 22 good standing from an accredited school of 23 allopathic medicine or osteopathic medicine 24 in the United States during the 5-year pe- 25 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 7 •HR 4974 IH riod immediately preceding the date on 1 which the physician first registers or re- 2 news under this section and has success- 3 fully completed a comprehensive allopathic 4 or osteopathic medicine curriculum or ac- 5 credited medical residency that— 6 ‘‘(I) included not less than 8 7 hours of training on treating and 8 managing patients with opioid and 9 other substance use disorders; and 10 ‘‘(II) included, at a minimum— 11 ‘‘(aa) the training described 12 in subclauses (I) through (VIII) 13 of clause (iv); and 14 ‘‘(bb) training with respect 15 to any other best practice the 16 Secretary determines should be 17 included in the curriculum, which 18 may include training on pain 19 management, including assess- 20 ment and appropriate use of 21 opioid and non-opioid alter- 22 natives. 23 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 8 •HR 4974 IH ‘‘(B) If the practitioner is not a physician, 1 the practitioner must meet one or more of the 2 following conditions: 3 ‘‘(i) Completed not fewer than 24 4 hours of initial training addressing each of 5 the topics listed in subparagraph (A)(iv) 6 (through classroom situations, seminars at 7 professional society meetings, electronic 8 communications, or otherwise) provided by 9 the American Society of Addiction Medi- 10 cine, the American Academy of Addiction 11 Psychiatry, the American Medical Associa- 12 tion, the American Osteopathic Associa- 13 tion, the American Nurses Credentialing 14 Center, the American Psychiatric Associa- 15 tion, the American Association of Nurse 16 Practitioners, the American Academy of 17 Physician Assistants, or any other organi- 18 zation that the Secretary determines is ap- 19 propriate for purposes of this clause. 20 ‘‘(ii) Has such other training or expe- 21 rience as the Secretary determines will 22 demonstrate the ability of the practitioner 23 to treat and manage patients with opioid 24 and other substance use disorders. 25 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 9 •HR 4974 IH ‘‘(iii) Graduated in good standing 1 from an accredited physician assistant 2 school or school of advanced practice nurs- 3 ing in the United States during the 5-year 4 period immediately preceding the date on 5 which the practitioner first registers or re- 6 news under this section and has success- 7 fully completed a comprehensive physician 8 assistant or advanced practice nursing cur- 9 riculum that includes not less than 24 10 hours of training on treating and man- 11 aging patients with opioid and other sub- 12 stance use disorders and, at a minimum— 13 ‘‘(I) the training described in 14 subclauses (I) through (VIII) of sub- 15 paragraph (A)(iv); and 16 ‘‘(II) training with respect to any 17 other best practice the Secretary de- 18 termines should be included in the 19 curriculum, which may include train- 20 ing on pain management, including 21 assessment and appropriate use of 22 opioid and non-opioid alternatives. 23 ‘‘(3) RECIPROCAL TREATMENT.— 24 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 10 •HR 4974 IH ‘‘(A) PHYSICIANS.—A physician who meets 1 one or more of the conditions listed in para- 2 graph (2)(A) is deemed to meet one or more of 3 the conditions listed in subsection (g)(2)(G)(ii), 4 and a physician who meets one or more of the 5 conditions listed in subsection (g)(2)(G)(ii) is 6 deemed to meet one or more of the conditions 7 listed in paragraph (2)(A). 8 ‘‘(B) OTHER PRACTITIONERS.—A practi- 9 tioner who is not a physician, and who meets 10 one or more of the conditions listed in para- 11 graph (2)(B), is deemed to meet one or more 12 of the conditions listed in subsection 13 (g)(2)(G)(iv)(II), and a practitioner who is not 14 a physician, and who meets one or more of the 15 conditions listed in subsection (g)(2)(G)(iv)(II), 16 is deemed to meet one or more of the conditions 17 listed in paragraph (2)(B).’’. 18 (b) TRAINING REQUIRED.— 19 (1) PHYSICIANS.—Section 20 303(g)(2)(G)(ii)(IV)(hh) of the Controlled Sub- 21 stances Act (21 U.S.C. 823(g)(2)(G)(ii)(IV)) is 22 amended by inserting ‘‘such as prevention of addic- 23 tion,’’ after ‘‘other best practices,’’. 24 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 11 •HR 4974 IH (2) OTHER PRACTITIONERS.—Section 1 303(g)(2)(G)(iv)(II) of the Controlled Substances 2 Act (21 U.S.C. 823(g)(2)(G)(iv)(II)) is amended— 3 (A) in item (aa), by striking ‘‘or’’ at the 4 end; 5 (B) in item (bb), by striking the period at 6 the end and inserting ‘‘; or’’; and 7 (C) by adding at the end the following new 8 item: 9 ‘‘(cc) graduated in good standing from an 10 accredited physician assistant school or school 11 of advanced practice nursing in the United 12 States during the 5-year period immediately 13 preceding the date on which the practitioner 14 submits to the Secretary a written notification 15 under subparagraph (B) and has successfully 16 completed a comprehensive physician assistant 17 or advanced practice nursing curriculum that 18 includes not less than 24 hours of training on 19 treating and managing opioid-dependent pa- 20 tients and, at a minimum— 21 ‘‘(AA) the training described in items 22 (aa) through (hh) of clause (ii)(IV); and 23 ‘‘(BB) training with respect to any 24 other best practice the Secretary deter- 25 VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS 12 •HR 4974 IH mines should be included in the cur- 1 riculum, which may include training on 2 pain management, including assessment 3 and appropriate use of opioid and non- 4 opioid alternatives.’’. 5 (3) TECHNICAL CORRECTION.—Section 6 303(g)(2)(G)(iv)(II)(bb) of the Controlled Sub- 7 stances Act (21 U.S.C. 823(g)(2)(G)(iv)(II)(bb)) is 8 amended by striking ‘‘has’’ before ‘‘such other train- 9 ing’’. 10 Æ VerDate Sep 11 2014 00:04 Nov 13, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H4974.IH H4974 kjohnson on DSK79L0C42 with BILLS