[House Report 115-144]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-144
======================================================================
VA PRESCRIPTION DATA ACCOUNTABILITY ACT 2017
_______
May 22, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1545]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1545) to amend title 38, United States Code, to
clarify the authority of the Secretary of Veterans Affairs to
disclose certain patient information to State controlled
substance monitoring programs, and for other purposes, having
considered the same, report favorably thereon without amendment
and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 5
Constitutional Authority Statement............................... 5
Applicability to Legislative Branch.............................. 5
Statement on Duplication of Federal Programs..................... 5
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 6
Purpose and Summary
H.R. 1545, the VA Prescription Data Accountability Act of
2017, was introduced by Representative Ann M. Kuster of New
Hampshire on March 15, 2017.
H.R. 1545 would require the Department of Veterans Affairs
(VA) to disclose information about any individual who is
dispensed medication prescribed by a VA employee or a non-VA
provider authorized by VA to a state prescription drug
monitoring program (PDMP) to the extent necessary to prevent
misuse and diversion of prescription medication.
Background and Need for Legislation
Section 2. Secretary of Veterans Affairs disclosure of patient
information to state controlled Substance Monitoring Programs
State PDMPs are statewide electronic databases that are
used to address prescription drug abuse, addiction, and
diversion through the collection and distribution of data on
substances dispensed in a given state to authorized individuals
or entities.\1\ According to the National Alliance for Model
State Drug Laws, PDMPs can be beneficial in: supporting access
to legitimate medical use of controlled substances; identifying
and deterring drug abuse and diversion; facilitating and
encouraging the identification of persons addicted to
prescription drugs and subsequent intervention and treatment;
and, informing public health initiatives through outlining of
use and abuse trends.\2\
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\1\U.S. Department of Justice--Drug Enforcement Administration.
State Prescription Drug Monitoring Programs, https://
www.deadiversion.usdoj.gov/faq/rx_monitor.htm#1. Accessed May 18, 2017.
\2\Ibid.
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Sec. 5701(l) of title 38 United States Code (U.S.C.)
requires VA to disclose information to PDMPs for either a
veteran or the dependent of a veteran who is prescribed
medication through VA. However, VA's current information
technology (IT) system is unable to differentiate between a
dependent of a veteran and other non-veterans and, as a result,
VA only transmits veteran data to PDMPs.\3\ This leaves out
approximately 10% of VA's patient population who are non-
veterans and who may be prescribed medication from VA that is
not shared with State PDMPs. In FY 2017, that translated to
approximately 715,928 patients. Non-veterans who may receive
prescriptions from VA include: descendants of veterans;
caregivers of veterans; individuals receiving disaster relief
from VA; TRICARE beneficiaries, active duty service members, or
others who receive VA care through sharing agreements with
either the Department of Defense or academic affiliates; or, VA
staff. The Committee is concerned about ongoing public health
risks of the misuse or diversion of prescription medication,
which may be exacerbated by VA's failure to provide information
about all VA patients--veterans and non-veterans--to PDMPs.
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\3\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Representative
Ann M. Kuster).
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Section 2 of the bill would require VA to disclose
information to PDMPs for anyone--veteran or non-veteran--who is
prescribed medication through the VA healthcare system.
According to VA, enactment of section 2 would, ``. . . provide
an important authority to ensure that VA is able to fulfill its
public health role in sharing vital clinical information to
help guide treatment decisions.''\4\
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\4\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Jennifer S. Lee,
Deputy Under Secretary for Health for Policy and Services, Veterans
Health Administration, U.S. Department of Veterans Affairs).
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Hearings
There were no full Committee hearings held on H.R. 1545.
On March 29, 2017, the Subcommittee on Health conducted a
legislative hearing on a number of bills including H.R. 1545.
The following witnesses testified:
The Honorable David. P. Roe M.D. of Tennessee; The
Honorable Jackie Walorski of Indiana; The Honorable
Doug Collins of Georgia; The Honorable Mike Coffman of
Colorado; The Honorable Stephen Knight of California;
The Honorable Ann M. Kuster of New Hampshire; Jennifer
S. Lee, M.D., the Deputy Under Secretary for Health for
Policy and Services for the Veterans Health
Administration of the U.S. Department of Veterans
Affairs who was accompanied by Susan Blauert, the Chief
Counsel for the Health Care Law Group of the Office of
the General Counsel for the U.S. Department of Veterans
Affairs; Kayda Keleher, Legislative Associate for the
National Legislative Service of the Veterans of Foreign
Wars of the United States; Shurhonda Y. Love, the
Assistant National Legislative Director for the
Disabled American Veterans; and, Sarah S. Dean, the
Associate Legislative Director for the Paralyzed
Veterans of America.
Statements for the record were submitted by:
The Honorable Lee Zeldin of New York; The American
Legion; the National Association of State Veteran
Homes; Swords to Plowshares; and, the Wounded Warrior
Project.
Subcommittee Consideration
On April 6, 2017, the Subcommittee on Health met in an open
markup session, a quorum being present, and ordered H.R. 1545
to be reported favorably to the full Committee by voice vote.
Committee Consideration
On May 17, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 1545 to be
reported favorably to the House of Representatives by voice
vote. A motion by Representative Tim Walz of Minnesota, Ranking
Member of the Committee on Veterans' Affairs, to report H.R.
1545 favorably to the House of Representatives was agreed to by
voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 1545
reported to the House.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to ensure a complete and accurate
transmittal of prescription information from VA to PDMPs.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 1545 does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
1545 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 1545 provided by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 19, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1545, the VA
Prescription Data Accountability Act 2017.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall.
Enclosure.
H.R. 1545--VA Prescription Data Accountability Act 2017
H.R. 1545 would require the Department of Veterans Affairs
(VA) to disclose to state programs that monitor prescription
drugs certain information about all people who receive
prescriptions from VA. Under current law, VA is required to
disclose such information only for veterans or their dependents
who are prescribed medication through VA. H.R. 1545 would
expand that group to include anyone who is prescribed
medication through VA, including descendants of veterans, staff
at VA, and individuals receiving disaster relief. CBO estimates
that implementing the bill would cost less than $500,000 over
the 2018-2022 period, primarily to prepare the necessary
regulations; that spending would be subject to the availability
of appropriated funds.
Enacting H.R. 1545 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply. CBO
estimates that enacting H.R. 1545 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2028.
The bill contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act, and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was approved by H. Samuel Papenfuss, Deputy
Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1545 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1545.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1545 is authorized by Congress' power to
``provide for the common Defense and general Welfare of the
United States.''
Applicability To Legislative Branch
The Committee finds that H.R. 1545 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015),
the Committee finds that no provision of H.R. 1545 establishes
or reauthorizes a program of the Federal Government known to be
duplicative of another Federal program, a program that was
included in any report from the Government Accountability
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most
recent Catalog of Federal Domestic Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015),
the Committee estimates that H.R. 1545 contains no directed
rulemaking that would require the Secretary to prescribe
regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide a short title of the
``VA Prescription Data Accountability Act of 2017''.
Section 2. Secretary of Veterans Affairs disclosure of patient
information to state controlled Substance Monitoring Programs
Section 2 of the bill would amend section 5701(1) of title
38 U.S.C. by:
(1) inserting ``(1)'' before ``Under'';
(2) striking ``a veteran or the dependent of a
veteran'' and inserting ``a covered individual'';
(3) adding at the end a new paragraph that would
stipulate that a ``covered individual'' is an
individual who is dispensed medication prescribed by a
VA employee or by a provider authorized by VA to
prescribe such medication.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 57--RECORDS AND INVESTIGATIONS
* * * * * * *
SUBCHAPTER I--RECORDS
Sec. 5701. Confidential nature of claims
(a) All files, records, reports, and other papers and
documents pertaining to any claim under any of the laws
administered by the Secretary and the names and addresses of
present or former members of the Armed Forces, and their
dependents, in the possession of the Department shall be
confidential and privileged, and no disclosure thereof shall be
made except as provided in this section.
(b) The Secretary shall make disclosure of such files,
records, reports, and other papers and documents as are
described in subsection (a) of this section as follows:
(1) To a claimant or duly authorized agent or
representative of a claimant as to matters concerning
the claimant alone when, in the judgment of the
Secretary, such disclosure would not be injurious to
the physical or mental health of the claimant and to an
independent medical expert or experts for an advisory
opinion pursuant to section 5109 or 7109 of this title.
(2) When required by process of a United States court
to be produced in any suit or proceeding therein
pending.
(3) When required by any department or other agency
of the United States Government.
(4) In all proceedings in the nature of an inquest
into the mental competency of a claimant.
(5) In any suit or other judicial proceeding when in
the judgment of the Secretary such disclosure is deemed
necessary and proper.
(6) In connection with any proceeding for the
collection of an amount owed to the United States by
virtue of a person's participation in any benefit
program administered by the Secretary when in the
judgment of the Secretary such disclosure is deemed
necessary and proper.
(c)(1) The amount of any payment made by the Secretary to any
person receiving benefits under a program administered by the
Secretary shall be made known to any person who applies for
such information.
(2) Any appraisal report or certificate of reasonable value
submitted to or prepared by the Secretary in connection with
any loan guaranteed, insured, or made under chapter 37 of this
title shall be made available to any person who applies for
such report or certificate.
(3) Subject to the approval of the President, the Secretary
may publish at any time and in any manner any or all
information of record pertaining to any claim filed with the
Secretary if the Secretary determines that the public interest
warrants or requires such publication.
(d) The Secretary as a matter of discretion may authorize an
inspection of Department records by duly authorized
representatives of recognized organizations.
(e) Except as otherwise specifically provided in this section
with respect to certain information, the Secretary may release
information, statistics, or reports to individuals or
organizations when in the Secretary's judgment such release
would serve a useful purpose.
(f) The Secretary may, pursuant to regulations the Secretary
shall prescribe, release the name or address, or both, of any
present or former member of the Armed Forces, or a dependent of
a present or former member of the Armed Forces, (1) to any
nonprofit organization if the release is directly connected
with the conduct of programs and the utilization of benefits
under this title, or (2) to any criminal or civil law
enforcement governmental agency or instrumentality charged
under applicable law with the protection of the public health
or safety if a qualified representative of such agency or
instrumentality has made a written request that such name or
address be provided for a purpose authorized by law. Any
organization or member thereof or other person who, knowing
that the use of any name or address released by the Secretary
pursuant to the preceding sentence is limited to the purpose
specified in such sentence, willfully uses such name or address
for a purpose other than those so specified, shall be guilty of
a misdemeanor and be fined not more than $5,000 in the case of
a first offense and not more than $20,000 in the case of any
subsequent offense.
(g)(1) Subject to the provisions of this subsection, and
under regulations which the Secretary shall prescribe, the
Secretary may release the name or address, or both, of any
person who is a present or former member of the Armed Forces,
or who is a dependent of a present or former member of the
Armed Forces, to a consumer reporting agency if the release of
such information is necessary for a purpose described in
paragraph (2) of this subsection.
(2) A release of information under paragraph (1) of this
subsection concerning a person described in such paragraph may
be made for the purpose of--
(A) locating such a person--
(i) who has been administratively determined
to be indebted to the United States by virtue
of the person's participation in a benefits
program administered by the Secretary; or
(ii) if the Secretary has determined under
such regulations that (I) it is necessary to
locate such person in order to conduct a study
pursuant to section 527 of this title or a
study required by any other provision of law,
and (II) all reasonable steps have been taken
to assure that the release of such information
to such reporting agency will not have an
adverse effect on such person; or
(B) Obtaining a consumer report in order to assess
the ability of a person described in subparagraph
(A)(i) of this paragraph to repay the indebtedness of
such person to the United States, but the Secretary may
release the name or address of such person for the
purpose stated in this clause only if the Secretary
determines under such regulations that such person has
failed to respond appropriately to administrative
efforts to collect such indebtedness.
(3) The Secretary may also release to a consumer reporting
agency, for the purposes specified in subparagraph (A) or (B)
of paragraph (2) of this subsection, such other information as
the Secretary determines under such regulations is reasonably
necessary to identify a person described in such paragraph,
except that the Secretary may not release to a consumer
reporting agency any information which indicates any
indebtedness on the part of such person to the United States or
any information which reflects adversely on such person. Before
releasing any information under this paragraph, the Secretary
shall, under such regulations, take reasonable steps to provide
for the protection of the personal privacy of persons about
whom information is proposed to be released under this
paragraph.
(4)(A) If the Secretary determines, under regulations which
the Secretary shall prescribe, that a person described in
paragraph (1) of this subsection has failed to respond
appropriately to reasonable administrative efforts to collect
an indebtedness of such person described in paragraph (2)(A)(i)
of this subsection, the Secretary may release information
concerning the indebtedness, including the name and address of
such person, to a consumer reporting agency for the purpose of
making such information available for inclusion in consumer
reports regarding such person and, if necessary, for the
purpose of locating such person, if--
(i) the Secretary has (I) made reasonable efforts to
notify such person of such person's right to dispute
through prescribed administrative processes the
existence or amount of such indebtedness and of such
person's right to request a waiver of such indebtedness
under section 5302 of this title, (II) afforded such
person a reasonable opportunity to exercise such
rights, and (III) made a determination with respect to
any such dispute or request; and
(ii) thirty calendar days have elapsed after the day
on which the Secretary has made a determination that
reasonable efforts have been made to notify such person
(I) that the Secretary intends to release such
information for such purpose or purposes, and (II)
that, upon the request of such person, the Secretary
shall inform such person of whether such information
has been so released and of the name and address of
each consumer reporting agency to which such
information was released by the Secretary and of the
specific information so released.
(B) After release of any information under subparagraph (A)
of this paragraph concerning the indebtedness of any person,
the Secretary shall promptly notify--
(i) each consumer reporting agency to which such
information has been released by the Secretary; and
(ii) each consumer reporting agency described in
subsection (i)(3)(B)(i) of this section to which such
information has been transmitted by the Secretary
through a consumer reporting agency described in
subsection (i)(3)(B)(ii)(I) of this section,
of any substantial change in the status or amount of such
indebtedness and, upon the request of any such consumer
reporting agency for verification of any or all information so
released, promptly verify or correct, as appropriate, such
information. The Secretary shall also, after the release of
such information, inform such person, upon the request of such
person, of the name and address of each consumer reporting
agency described in clause (i) or (ii) of this subparagraph to
which such information was released or transmitted by the
Secretary and of the specific information so released or
transmitted.
(h)(1) Under regulations which the Secretary shall prescribe,
the Secretary may release the name or address, or both, of any
person who is a present or former member of the Armed Forces,
or who is a dependent of a present or former member of the
Armed Forces (and other information relating to the identity of
such person), to any person in a category of persons described
in such regulations and specified in such regulations as a
category of persons to whom such information may be released,
if the release of such information is necessary for a purpose
described in paragraph (2) of this subsection.
(2) A release of information under paragraph (1) of this
subsection may be made for the purpose of--
(A) determining the creditworthiness, credit
capacity, income, or financial resources of a person
who has (i) applied for any benefit under chapter 37 of
this title, or (ii) submitted an offer to the Secretary
for the purchase of property acquired by the Secretary
under section 3720(a)(5) of this title;
(B) verifying, either before or after the Secretary
has approved a person's application for assistance in
the form of a loan guaranty or loan insurance under
chapter 37 of this title, information submitted by a
lender to the Secretary regarding the creditworthiness,
credit capacity, income, or financial resources of such
person;
(C) offering for sale or other disposition by the
Secretary, pursuant to section 3720 of this title, any
loan or installment sale contract owned or held by the
Secretary; or
(D) providing assistance to any applicant for
benefits under chapter 37 of this title or
administering such benefits if the Secretary promptly
records the fact of such release in appropriate records
pertaining to the person concerning whom such release
was made.
(i)(1) No contract entered into for any of the purposes of
subsection (g) or (h) of this section, and no action taken
pursuant to any such contract or either such subsection, shall
result in the application of section 552a of title 5 to any
consumer reporting agency or any employee of a consumer
reporting agency.
(2) The Secretary shall take reasonable steps to provide for
the protection of the personal privacy of persons about whom
information is disclosed under subsection (g) or (h) of this
section.
(3) For the purposes of this subsection and of subsection (g)
of this section--
(A) The term ``consumer report'' has the meaning
provided such term in subsection (d) of section 603 of
the Fair Credit Reporting Act (15 U.S.C. 1681a(d)).
(B) The term ``consumer reporting agency'' means--
(i) a consumer reporting agency as such term
is defined in subsection (f) of section 603 of
the Fair Credit Reporting Act (15 U.S.C.
1681a(f)), or
(ii) any person who, for monetary fees, dues,
or on a cooperative nonprofit basis, regularly
engages in whole or in part in the practice of
(I) obtaining credit or other information on
consumers for the purpose of furnishing such
information to consumer reporting agencies (as
defined in clause (i) of this paragraph), or
(II) serving as a marketing agent under
arrangements enabling third parties to obtain
such information from such reporting agencies.
(j) Except as provided in subsection (i)(1) of this section,
any disclosure made pursuant to this section shall be made in
accordance with the provisions of section 552a of title 5.
(k)(1)(A) Under regulations that the Secretary shall
prescribe, the Secretary may disclose the name and address of
any individual described in subparagraph (C) to an entity
described in subparagraph (B) in order to facilitate the
determination by such entity whether the individual is, or
after death will be, a suitable organ, tissue, or eye donor
if--
(i) the individual is near death (as determined by
the Secretary) or is deceased; and
(ii) the disclosure is permitted under regulations
promulgated pursuant to section 264 of the Health
Insurance Portability and Accountability Act of 1996
(42 U.S.C. 1320d-2 note).
(B) An entity described in this subparagraph is--
(i) an organ procurement organization, including eye
and tissue banks; or
(ii) an entity that the Secretary has determined--
(I) is substantially similar in function,
professionalism, and reliability to an organ
procurement organization; and
(II) should be treated for purposes of this
subsection in the same manner as an organ
procurement organization.
(C) An individual described in this subparagraph is--
(i) a veteran; or
(ii) a dependent of veteran.
(2) In this subsection, the term ``organ procurement
organization'' has the meaning given the term ``qualified organ
procurement organization'' in section 371(b) of the Public
Health Service Act (42 U.S.C. 273(b)).
(l)(1) Under regulations the Secretary shall prescribe, the
Secretary shall disclose information about [a veteran or the
dependent of a veteran] a covered individual to a State
controlled substance monitoring program, including a program
approved by the Secretary of Health and Human Services under
section 399O of the Public Health Service Act (42 U.S.C. 280g-
3), to the extent necessary to prevent misuse and diversion of
prescription medicines.
(2) In this subsection, a ``covered individual'' is an
individual who is dispensed medication prescribed by an
employee of the Department or by a non-Department provider
authorized to prescribe such medication by the Department.
* * * * * * *
[all]