Sec. 106. Reports and investigation on use of opioids in treatment by Department of Veterans Affairs
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Not later than two years after the date of the enactment of this Act, 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 Department. The report submitted under paragraph
(1)shall include the following: Recommendations on such improvements to the Opioid Safety Initiative of the Department as the Comptroller General considers appropriate. Information with respect to— deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider of the Department; overall prescription rates and prescriptions indications of opioids at all medical facilities of the Department to treat non-cancer, non-palliative, and non-hospice care patients, including whether each medical facility or health care provider of the Department is among the top ten percent of medical facilities or health care providers of the Department with respect to such prescription rates; the prescription rates and prescriptions indications of benzodiazepines and opioids concomitantly by health care providers of the Department, including whether each medical facility or health care provider of the Department is among the top ten percent of medical facilities or health care providers of the Department with respect to such prescription rates; the practice by health care providers of the Department of prescribing opioids to treat patients without any pain, including to treat patients with mental health disorders other than opioid use disorder; and the effectiveness of opioid therapy for patients receiving such therapy, including the effectiveness of long-term opioid therapy. Recommendations with respect to whether sanctions are needed, such as written warnings or performance improvement plans, for health care providers of the Department that are— not practicing at a level meeting or exceeding the minimum level standard of care established by the Department; and not following the enhanced guidance with respect to absolute contraindications for opioid therapy set forth in the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, as updated under section 101. Not later than 180 days after the date of the enactment of this Act, and not later than 30 days after the end of each quarter thereafter, 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 Department of Veterans Affairs during the period covered by the report to address any outstanding findings and recommendations by the Comptroller General of the United States with respect to the Veterans Health Administration. Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter, 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 report that contains, for the one year period preceding the submittal of the report, the following: The number of patients and the percentage of the patient population of the Department of Veterans Affairs who were prescribed benzodiazepines and opioids concurrently by a health care provider of the Department. 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 Department, including those who were prescribed benzodiazepines and opioids concurrently. The number of non-cancer, non-palliative, 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-basis. The number of non-cancer, non-palliative, 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 a health care provider of the Department. With respect to each medical facility of the Department, information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients, including information on— 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 facility; the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which opioids or benzodiazepines are not an approved treatment and the aggregate such prescription rate for all health care providers at the facility; 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 such prescription rate for all health care providers at the facility; and 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 such prescription rate for all health care providers at the facility. With respect to each medical facility of the Department, 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 a medication to a veteran. If a report submitted under paragraph
(1)indicates that a prescription rate described in subparagraph
(E)of such paragraph at a medical facility of the Department is among the top ten percent of medical facilities of the Department with respect to such prescription rate, the Secretary shall— through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the medical facility; and immediately notify the Committee on Veterans Affairs’ of the Senate, the Committee on Veterans Affairs’ of the House of Representatives, and each Member of the Senate and the House of Representatives who represents the area in which the medical facility is located. In this section, the term prescription rate means, with respect to a health care provider or medical facility of the Department, each of the following: The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total patient population of that health care provider or medical facility. The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids. Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.