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Bipartisan Omnibus Big Win for Wisconsin Veterans

As a member of the Senate Appropriations Committee, Baldwin secured several bipartisan provisions for Wisconsin veterans and their families

WASHINGTON, D.C. – U.S. Senator Tammy Baldwin released the following statement after President Obama signed into law the Consolidated Appropriations Act of 2016, which included several provisions Senator Baldwin championed on behalf of Wisconsin veterans and their families:

“I was proud to usher in this legislation which rolls back devastating budget cuts to veterans and includes many reforms that I have fought for and support. As a member of the Senate Appropriations Committee, I fought to include provisions in this legislation that would improve transparency of VA Office of Inspector General reports, strengthen protections for whistleblowers, and provide stronger oversight of the VA’s prescribing practices. These are significant reforms that take a serious step in the right direction to ensure we address underlying challenges at the VA.”

Earlier this month, the Senate Committee on Veterans’ Affairs passed an updated version of Senator Baldwin’s Jason Simcakoski Memorial Opioid Safety Act, a bill aimed at providing safer and more effective pain management services to our nation’s veterans. Senate Committee on Veterans’ Affairs Chairman Johnny Isakson (R-GA) said Senator Baldwin’s bill would be viewed as one of the “great accomplishments” of the committee.

As a member of the Senate Appropriations Committee, Senator Baldwin championed the following provisions in the new law:

Opioid Drug Abuse Prevention Funding

Senator Baldwin is a strong supporter of increased funding for opioid and prescription drug abuse prevention, treatment and research programs. As a member of the Senate Appropriations Committee, Senator Baldwin led a call to strengthen federal investments to combat the growing prescription drug and opioid abuse epidemic in America, including support for the Centers for Disease Control and Prevention’s (CDC) Prevention for States program. As a result of Senator Baldwin’s advocacy, the Consolidated Appropriations Act of 2016 includes robust funding for opioid abuse prevention efforts at the CDC and the Substance Abuse & Mental Health Services Administration (SAMHSA), including $70 million for CDC’s prescription drug abuse overdose prevention and monitoring activities. This investment allows CDC to strengthen and expand its prevention program to all 50 states and to continue to develop safe opioid prescribing guidelines.

VA Inspector General Transparency Improvements

Senator Baldwin, along with Appropriations Subcommittee on MilCon/VA Chairman Mark Kirk (R-IL), authored a provision regarding increasing transparency at the VA Office of Inspector General (OIG).  Based on an amendment Senator Baldwin included in S.579, the Inspector General Empowerment Act, the joint Baldwin-Kirk amendment would amend current law to ensure that when the VA OIG completes a report, it is promptly shared with the VA Secretary, Congress, and the public. This bill language would help address failures of transparency and agency oversight by requiring recommendations made by the VA OIG during investigations, audits or other reports to be sent directly to the VA Secretary. In addition, these recommendations would be available to the public and submitted directly to relevant Congressional oversight committees. Lastly, if the Inspector General initiated an investigation based on information provided by an individual, the recommendations would also be shared with that individual.

Drug Diversion at Veterans Health Administration Facilities

As a member of the Senate Appropriations Committee, Senator Baldwin successfully worked to include language in the Consolidated Appropriations Act of 2016 that urges the Drug Enforcement Administration (DEA) to maintain open communication with the Veterans Health Administration (VHA) and treat investigations of drug diversion in VHA facilities as a priority. DEA shall report to the Committee within 90 days after the enactment of this act on its drug diversion investigations involving VHA facilities and to report on the status of investigations on a quarterly basis thereafter.

The initial report shall include: the number of ongoing DEA drug diversion investigations into VHA facilities, the number of DEA drug diversion investigations into VHA facilities concluded in the prior year, an analysis of trends in DEA and VHA drug diversion investigations over the past 10 years, the number of investigations that resulted in indictments, a review of factors that may be leading to drug diversion including VHA prescription drug prescribing practices, and recommendations or best practices to prevent drug diversion from VHA facilities.

Whistleblower Enhancement for VA Medical Professionals

Closes an existing legal loophole that harms VA medical professionals who have experienced whistleblower retaliation in the form of a negative personnel evaluation. Currently, the Office of Special Counsel (OSC) cannot investigate these types of retaliation because VA medical professional personnel evaluations are governed by Title 38; while OSC’s relevant investigatory power is limited to personnel evaluations governed by Title 5. Senator Baldwin’s provision would address this inconsistency in the law by including personnel reviews governed by Title 38 within the scope of potential retaliatory personnel actions that OSC can investigate.

Update of Joint VA and DoD Clinical Practice Guidelines

To help address the prescription drug abuse and overdose epidemic, Senator Baldwin included a provision requiring the VA, working with DoD, to update the joint VA-DoD Clinical Practice Guideline (CPG) for the Management of Opioid Therapy (OT) for Chronic Pain, which has not been updated since 2010. In addition, to ensure prescribers have the most up-to-date science, VA will be required to adopt the safe opioid prescribing guidelines for chronic, non-cancer pain in outpatient settings currently being developed by the Centers for Disease Control and Prevention (CDC).

Expanded Access to Opioid Receptor Antagonists

Opioid receptor antagonists, such as naloxone, are drugs that reverse the effects of opioids, including respiratory depression, and, in certain cases, can prevent death. Indeed, the VA’s year-old Overdose Education and Naloxone Distribution (OEND) program, which dispenses take-home naloxone kit prescriptions to at-risk veterans, has been credited with saving 33 lives by reversing opioid overdoses. Senator Baldwin included a provision to expand this program, ensuring every VA medical facility is equipped with opioid receptor antagonists, as well as to improve provider and pharmacist education on overdose prevention strategies.

Joint Executive Council Working Group on Opioids and Pain Management

Senator Baldwin authored a provision to create a new joint VA-DoD working group to focus on patient pain management and opioid therapy.  This working group would be established within the DoD-VA Joint Executive Council—an existing forum for senior leadership at both Departments to develop policies and programs to address overlapping priorities—and would cover, at minimum, opioid prescribing practices, acute and chronic pain management, complementary and integrated health, and the concurrent use of opioids and prescription drugs for mental health issues, including benzodiazepines. The working group would help combat the VA’s continued overreliance on opioids for pain management; limit instances of VA providers prescribing opioids for mental health treatment, which is non-compliant with joint VA-DoD Clinical Practice Guidelines; and improve patient care during the DoD-VA transition.

Enhancing VHA Opioid Safety Efforts

VA has had some success improving the safe use of opioids to treat pain, including through the Opioid Safety Initiative (OSI) and the use of the Opioid Therapy Risk Report tool.  However, capability gaps exist in these initiatives, and more needs to be done. To help reduce rates of opioid addiction and fatal overdose, it is critical that real-time data is available at the individual prescriber and pharmacist level as well as the pharmacy management level to prevent inappropriate prescribing before it occurs.

Senator Baldwin included a provision that directs the VA to develop and deploy mechanisms for including real-time patient information on existing opioid prescriptions within VHA as well as patient controlled substances prescription information in the state prescription drug monitoring programs.  The mechanisms must also alert a provider or pharmacist in real-time that an opioid or benzodiazepine prescription would be inappropriate and protect against “double-prescribing” when an in-patient continues to receive take-home opioid prescriptions despite being treated with opioids at a VA facility.  The provision further directs VA to submit information on controlled substances prescriptions to state prescription drug monitoring programs.

GAO Audit of VA Opioid Therapy

According to the CDC, in 2012, health care providers wrote 259 million prescriptions for opioid pain relievers, which is enough for every American adult to have a bottle of pills. This drastic increase has also been seen in local VA facilities, including the Tomah VAMC in Wisconsin. To strengthen oversight of VA opioid prescribing practices, Senator Baldwin included a provision directing the Government Accountability Office, in consultation with the Department of Veterans Affairs, to report to Congress on the effectiveness of the VA Opioid Safety Initiative and overall opioid prescribing practices throughout the VA system. This report shall include recommendations on improvements to the Opioid Safety Initiative, deaths involving veterans prescribed opioids, overall opioid  prescription rates and indications at all VA facilities, including facilities and prescribers that are among the top ten percent in the nation regarding the percent of their patient population receiving opioids and the average dose per patient. In addition, the report shall note the use of benzodiazepines and opioid concomitantly and their prescription rates and indications along with facilities and prescribers that are among the top ten percent in the nation regarding the percent of their patient population receiving opioids and the average dose per patient. 

VISN Pain Management Boards and Complementary and Integrative Health

To further help reduce the inappropriate use of opioids and improve treatment for chronic pain such as through the use of complementary and integrative health, Senator Baldwin included a provision that encourages the VA to establish a pain management board within each Veterans Integrated Service Network (VISN) comprised of health care professionals and—to give veterans a greater role in their care—veteran patients and/or family members of a veteran patient. The pain management boards would serve as a resource for the region’s facilities, patients, and family members; provide best practices recommendations for pain management to the VA facilities within its region, including patient, family member and medical perspectives; provide an annual report to the Secretary of Veterans Affairs about pain management practices within its region, which would then be sent to Congress.

GAO Report High Risk List

In 2015 GAO placed VHA on its annual High Risk List, identifying VHA programs as high-risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement or the need for transformation to address economy, efficiency, or effectiveness challenges. Accordingly, Senator Baldwin included language to require the VA Secretary to issue to Congress quarterly progress reports on Department action to address GAO findings and recommendations.

Armed Forces Retirement Home (AFRH)

The bill includes a provision authored by Senator Baldwin requiring the AFRH to report on actions taken to implement recommendations made by the Department of Defense Inspector General (DoD IG) in a July 2014 report.