[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5774 Engrossed in House (EH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5774
_______________________________________________________________________
AN ACT
To require the Secretary of Health and Human Services to develop
guidance on pain management and opioid use disorder prevention for
hospitals receiving payment under part A of the Medicare program,
provide for opioid quality measures development, and provide for a
technical expert panel on reducing surgical setting opioid use and data
collection on perioperative opioid use, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Combating Opioid Abuse for Care in
Hospitals Act of 2018'' or the ``COACH Act of 2018''.
SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT AND OPIOID USE DISORDER
PREVENTION FOR HOSPITALS RECEIVING PAYMENT UNDER PART A
OF THE MEDICARE PROGRAM.
(a) In General.--Not later than January 1, 2019, the Secretary of
Health and Human Services (in this section referred to as the
``Secretary'') shall develop and publish on the public website of the
Centers for Medicare & Medicaid Services guidance for hospitals
receiving payment under part A of title XVIII of the Social Security
Act (42 U.S.C. 1395c et seq.) on pain management strategies and opioid
use disorder prevention strategies with respect to individuals entitled
to benefits under such part.
(b) Consultation.--In developing the guidance described in
subsection (a), the Secretary shall consult with relevant stakeholders,
including--
(1) medical professional organizations;
(2) providers and suppliers of services (as such terms are
defined in section 1861 of the Social Security Act (42 U.S.C.
1395x));
(3) health care consumers or groups representing such
consumers; and
(4) other entities determined appropriate by the Secretary.
(c) Contents.--The guidance described in subsection (a) shall
include, with respect to hospitals and individuals described in such
subsection, the following:
(1) Best practices regarding evidence-based screening and
practitioner education initiatives relating to screening and
treatment protocols for opioid use disorder, including--
(A) methods to identify such individuals at-risk of
opioid use disorder, including risk stratification;
(B) ways to prevent, recognize, and treat opioid
overdoses; and
(C) resources available to such individuals, such
as opioid treatment programs, peer support groups, and
other recovery programs.
(2) Best practices for such hospitals to educate
practitioners furnishing items and services at such hospital
with respect to pain management and substance use disorders,
including education on--
(A) the adverse effects of prolonged opioid use;
(B) non-opioid, evidence-based, non-pharmacological
pain management treatments;
(C) monitoring programs for individuals who have
been prescribed opioids; and
(D) the prescribing of naloxone along with an
initial opioid prescription.
(3) Best practices for such hospitals to make such
individuals aware of the risks associated with opioid use
(which may include use of the notification template described
in paragraph (4)).
(4) A notification template developed by the Secretary, for
use as appropriate, for such individuals who are prescribed an
opioid that--
(A) explains the risks and side effects associated
with opioid use (including the risks of addiction and
overdose) and the importance of adhering to the
prescribed treatment regimen, avoiding medications that
may have an adverse interaction with such opioid, and
storing such opioid safely and securely;
(B) highlights multimodal and evidence-based non-
opioid alternatives for pain management;
(C) encourages such individuals to talk to their
health care providers about such alternatives;
(D) provides for a method (through signature or
otherwise) for such an individual, or person acting on
such individual's behalf, to acknowledge receipt of
such notification template;
(E) is worded in an easily understandable manner
and made available in multiple languages determined
appropriate by the Secretary; and
(F) includes any other information determined
appropriate by the Secretary.
(5) Best practices for such hospital to track opioid
prescribing trends by practitioners furnishing items and
services at such hospital, including--
(A) ways for such hospital to establish target
levels, taking into account the specialties of such
practitioners and the geographic area in which such
hospital is located, with respect to opioids prescribed
by such practitioners;
(B) guidance on checking the medical records of
such individuals against information included in
prescription drug monitoring programs;
(C) strategies to reduce long-term opioid
prescriptions; and
(D) methods to identify such practitioners who may
be over-prescribing opioids.
(6) Other information the Secretary determines appropriate,
including any such information from the Opioid Safety
Initiative established by the Department of Veterans Affairs or
the Opioid Overdose Prevention Toolkit published by the
Substance Abuse and Mental Health Services Administration.
SEC. 3. REQUIRING THE REVIEW OF QUALITY MEASURES RELATING TO OPIOIDS
AND OPIOID USE DISORDER TREATMENTS FURNISHED UNDER THE
MEDICARE PROGRAM AND OTHER FEDERAL HEALTH CARE PROGRAMS.
(a) In General.--Section 1890A of the Social Security Act (42
U.S.C. 1395aaa-1) is amended by adding at the end the following new
subsection:
``(g) Technical Expert Panel Review of Opioid and Opioid Use
Disorder Quality Measures.--
``(1) In general.--Not later than 180 days after the date
of the enactment of this subsection, the Secretary shall
establish a technical expert panel for purposes of reviewing
quality measures relating to opioids and opioid use disorders,
including care, prevention, diagnosis, health outcomes, and
treatment furnished to individuals with opioid use disorders.
The Secretary may use the entity with a contract under section
1890(a) and amend such contract as necessary to provide for the
establishment of such technical expert panel.
``(2) Review and assessment.--Not later than 1 year after
the date the technical expert panel described in paragraph (1)
is established (and periodically thereafter as the Secretary
determines appropriate), the technical expert panel shall--
``(A) review quality measures that relate to
opioids and opioid use disorders, including existing
measures and those under development;
``(B) identify gaps in areas of quality measurement
that relate to opioids and opioid use disorders, and
identify measure development priorities for such
measure gaps; and
``(C) make recommendations to the Secretary on
quality measures with respect to opioids and opioid use
disorders for purposes of improving care, prevention,
diagnosis, health outcomes, and treatment, including
recommendations for revisions of such measures, need
for development of new measures, and recommendations
for including such measures in the Merit-Based
Incentive Payment System under section 1848(q), the
alternative payment models under section 1833(z)(3)(C),
the shared savings program under section 1899, the
quality reporting requirements for inpatient hospitals
under section 1886(b)(3)(B)(viii), and the hospital
value-based purchasing program under section 1886(o).
``(3) Consideration of measures by secretary.--The
Secretary shall consider--
``(A) using opioid and opioid use disorder measures
(including measures used under the Merit-Based
Incentive Payment System under section 1848(q),
measures recommended under paragraph (2)(C), and other
such measures identified by the Secretary) in
alternative payment models under section 1833(z)(3)(C)
and in the shared savings program under section 1899;
and
``(B) using opioid measures described in
subparagraph (A), as applicable, in the quality
reporting requirements for inpatient hospitals under
section 1886(b)(3)(B)(viii),and in the hospital value-
based purchasing program under section 1886(o).
``(4) Prioritization of measure development.--The Secretary
shall prioritize for measure development the gaps in quality
measures identified under paragraph (2)(B).''.
(b) Expedited Endorsement Process for Opioid Measures.--Section
1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is
amended by adding at the end the following new flush sentence:
``Such endorsement process shall, as determined practicable by
the entity, provide for an expedited process with respect to
the endorsement of such measures relating to opioids and opioid
use disorders.''.
SEC. 4. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL SETTING OPIOID USE;
DATA COLLECTION ON PERIOPERATIVE OPIOID USE.
(a) Technical Expert Panel on Reducing Surgical Setting Opioid
Use.--
(1) In general.--Not later than 6 months after the date of
the enactment of this Act, the Secretary of Health and Human
Services shall convene a technical expert panel, including
medical and surgical specialty societies and hospital
organizations, to provide recommendations on reducing opioid
use in the inpatient and outpatient surgical settings and on
best practices for pain management, including with respect to
the following:
(A) Approaches that limit patient exposure to
opioids during the perioperative period, including pre-
surgical and post-surgical injections, and that
identify such patients at risk of opioid use disorder
pre-operation.
(B) Shared decision making with patients and
families on pain management, including recommendations
for the development of an evaluation and management
code for purposes of payment under the Medicare program
under title XVIII of the Social Security Act that would
account for time spent on shared decision making.
(C) Education on the safe use, storage, and
disposal of opioids.
(D) Prevention of opioid misuse and abuse after
discharge.
(E) Development of a clinical algorithm to identify
and treat at-risk, opiate-tolerant patients and reduce
reliance on opioids for acute pain during the
perioperative period.
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, the Secretary shall submit to Congress
and make public a report containing the recommendations
developed under paragraph (1) and an action plan for broader
implementation of pain management protocols that limit the use
of opioids in the perioperative setting and upon discharge from
such setting.
(b) Data Collection on Perioperative Opioid Use.--Not later than 1
year after the date of the enactment of this Act, the Secretary of
Health and Human Services shall submit to Congress a report that
contains the following:
(1) The diagnosis-related group codes identified by the
Secretary as having the highest volume of surgeries.
(2) With respect to each of such diagnosis-related group
codes so identified, a determination by the Secretary of the
data that is both available and reported on opioid use
following such surgeries, such as with respect to--
(A) surgical volumes, practices, and opioid
prescribing patterns;
(B) opioid consumption, including--
(i) perioperative days of therapy;
(ii) average daily dose at the hospital,
including dosage greater than 90 milligram
morphine equivalent;
(iii) post-discharge prescriptions and
other combination drugs that are used before
intervention and after intervention;
(iv) quantity and duration of opioid
prescription at discharge; and
(v) quantity consumed and number of
refills;
(C) regional anesthesia and analgesia practices,
including pre-surgical and post-surgical injections;
(D) naloxone reversal;
(E) post-operative respiratory failure;
(F) information about storage and disposal; and
(G) such other information as the Secretary may
specify.
(3) Recommendations for improving data collection on
perioperative opioid use, including an analysis to identify and
reduce barriers to collecting, reporting, and analyzing the
data described in paragraph (2), including barriers related to
technological availability.
SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE OF OPIOID PRESCRIBING
GUIDANCE FOR MEDICARE BENEFICIARIES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall post on the public
website of the Centers for Medicare & Medicaid Services all guidance
published by the Department of Health and Human Services on or after
January 1, 2016, relating to the prescribing of opioids and applicable
to opioid prescriptions for individuals entitled to benefits under part
A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.)
or enrolled under part B of such title of such Act (42 U.S.C. 1395j et
seq.).
(b) Update of Guidance.--
(1) Periodic update.--The Secretary shall, in consultation
with the entities specified in paragraph (2), periodically (as
determined appropriate by the Secretary) update guidance
described in subsection (a) and revise the posting of such
guidance on the website described in such subsection.
(2) Consultation.--The entities specified in this paragraph
are the following:
(A) Medical professional organizations.
(B) Providers and suppliers of services (as such
terms are defined in section 1861 of the Social
Security Act (42 U.S.C. 1395x)).
(C) Health care consumers or groups representing
such consumers.
(D) Other entities determined appropriate by the
Secretary.
Passed the House of Representatives June 19, 2018.
Attest:
Clerk.
115th CONGRESS
2d Session
H. R. 5774
_______________________________________________________________________
AN ACT
To require the Secretary of Health and Human Services to develop
guidance on pain management and opioid use disorder prevention for
hospitals receiving payment under part A of the Medicare program,
provide for opioid quality measures development, and provide for a
technical expert panel on reducing surgical setting opioid use and data
collection on perioperative opioid use, and for other purposes.